13371 (SFD)Building
Owner
T 6
4hf- 4 .�,QrctKra
P.O. BOX 1504
78.830 Irwin Circle LA QUINTA, CALIFORNIA 92253
Acac�.a Co�xs��tctio;�
BUILDING: TYPE CONST. - V K4 OCC: GRP. 4.1r3
604-232-012
A.P. Number
Lot 141 Tract 2.32$8 Phase 2
Legal Description
Project Description SIM Plan E
Acacia Homes
No. 13371
mailin
Address 8141 H. Keiser BlVd. 1310
City Zip Tel.
.Anahexmr CA 92808 (714)282-5800
Contractor
Sam
Address
City
ip
State Lic. $a„1 293954
& Classif.
Arch., Engr., . T OC Desi
Designer g
Ad.d ass_
�r.��l
• .f:Z.x�vine. Ave.
City 3612
Lic. # Sq. Ft. No. • No. Dw.
Size 2358 Stories Units
T1-714)641-1505
-714)641,,1505
Santa Ail a. Hell tstf CA 9116,911%
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm tha'l amt licensed under provisions of Chapter 9 (commencing with-.S,,�1000) of Division 3 of the'B siness an Professions Code, and my license is in�vfu11 fort
reffect. V, ar.e' •f is 7 /1
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec..7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he. is exempt therefrom, ,and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit '
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Bussness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con -
Strutt the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy l o!- Company
OFCopy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY t
I hereby affirm that there is a construction lending agency foe the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant -Date-
Mailing
ateMailing Address
City, State, Zip
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition,❑
Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Estimated Valuation
$135,69.00
Validation:
PERMIT ..
AMOUNT
Plan Chk. Dep.
-Plan Chk. Bal.
Const.
! . 7 tl
Mech..
�S + -
Electrical
�. •�
Plumbing
S.M.I.
Grading
10.
Driveway Enc.
f '
• fJ V
Infrastructure
3,033.07
S+`3 Y
Wit: kits '4tia9.23
TOTAL
4M-7.23
REMARKS
r..
ti
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE 2
^
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT. ®
STORAGE TANK
FORMS
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
(�`
H)
GAS (RO!HEATER
DRAINAGE PIPING
CAR P. SQ. FT. ®
OTHER APPJEOUIP.
I
WALL SQ. FT.
GAS (FI
DRINKING FOUNTAIN.
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
n
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
1AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
MIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR'
SETBACK
GROUND PLUMBING, NDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 2
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
(�`
H)
GAS (RO!HEATER
METER LOOP _
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FI
/ TEMP. POLE
GROUT
WATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP Aqq
FRAMING
FINAL INSP.
ROOFING I/
n
-1L
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 77 /
MESH
INSULATIONISOUND lb
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL