12841 (SFD)Building
Address 78-820 Irwin Cir
Owner Acacia Construction
ion
Mailin
Address 8141 S. uCaiseg Blvd. #310
City Zip T010282-5
Aaeirnt CA 9280
Contractor
Samir
Address
4
P.O. BOX 1504
78-105 CALLE ESTADO
cle LA QUINTA, CALIFORNIA 92253
ME
State Lic.�.395�
& Classif.
Des Arch.nergr DC DesiE, n
9
Ad r s45g Irvine Ave..
City Zip
No. 12841
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 604.-232-913
Legal Description Lot 142 Tract 23268
Project Description SPO Plan
AC't Ciak Homes
Tel.'
L
City
Lic. # Sq. Ft. 1280 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Tel
714) 641-1565
Santa Ana] He ghts s `i, g .Lp
LICENSED CONTRACTOR'S DECLARATION
jl hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Busisnessis and Professions Code, and my license is in full force an
effect. ri ti✓'�r�.•� L'�wit +.ar. - - -� f
SIGNATURE DATE
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, Buisness 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.) -
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct 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 contractor(s) 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.)
POIINo. / Company
„rCopy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WO RKE RS' 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
I hereby affirm that there is a construction lending agency for 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 it 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 sof this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
A
l
fl
stimated Valuation
PERMIT
V
AMOUNT
Plan Chk. 'Dep'.
ne
Plan Chk. Bal.
457.61
Const..
531.50.
Mech.
49.00
Electrical'
117.30
Plumbing
144.00
S.M.I.
7.60
Grading
20.00
Driveway Enc.
.00
Infrastructure
1,694.57 '
Validated by:
Validation:
-TOTAL.
—3,021. 50
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Ti
Front Setback from Cente
ne
;
Rear Setback from Rear Prop.-bne-
------..-ter
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
A.C. UNIT
�y
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
SEWER -
ROUGH WIRING
GAR. SQ. FT. @
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P: SQ. FT. @
HEATING (FINAL)
WALL SD. FT.
REINF. STEEL
DRINKING FOUNTAIN.
SQ. FT. @
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
_NOTE: Not to be used as property tax valuation
SERVICE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
$ plus x$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
—
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES 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 @ 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
GAR. FIREWALL
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
DERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
/
!/�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER -
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) O�
!
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
Ald
FINAL INSP.
n
7
FRAMING G Q
FINAL INSP.
ROOFING at
VENTILATION
L
7
Z Z
n
IJ/
/14
Y/VyJ
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING ��
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
G
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL