14361 (PAT). F 1
P.O. BOX 1504 N o . .1 3 61•
Building 78-780 Irwin Circle 78-495 CALLE TAMPICO
Address LA.OUINTA, CALIFORNIA 92253
Owner Acacia Construction ;
Mailing ' BUILDING: TYPE CONST. OCC; GRP..
Address $ Er* raiser Blvd.
A.P. Number
' . City - Zip Tel. .
a tiahlla$.M Iti CA 9280"� (7 10 2.82 -5000 Legal Description :.
Contractor Project Description ' Patin C£2t7r
same .
Address ,. .
Tel.'
State Lic.B. ?93�54 City 1612
& Classif.. L•ic. #
Sq. Ft. :NO..
,. .
-Arch., Engr.;:
Size - =Stories -
' 'Designer. New ❑ Add ❑: Alter ❑
Address Tel.
City Zip State
Lic. #
LICENSED, CONTRACTOR'S DECLARATION,:. '
Lherebyraffirm that I am licensed under provisions of Chapter,9 (commencing with 'Section
of Division 3 of the Business and Professions' Code, andmylicense is'in.full force and
effect 1f t•.
No. Dw
Units
Repair ❑ :.
Demolition ❑
•SIGNATURE DATE
OWNER BUILDER DECLARATION
I hereby that1 from
EstimatedValUatlOn
.
affirm am exempt the Contractor's License Law forAhe following
.reason:. (Sec. 703,1.5,Business--and. Professions CDde:,Any city -or county. -Which requires °a
-
!"
permit to construct, _after, Improve, demolish; or repair any structure,,.prior to, its •lssuance. also .
-, requires the applicant. for such permit. to Ra. signed statement. that he, is' licensed. pursuant to
-• . PERM...-
PERMIT...NIT.
AMOUNT. -
the provisions of the Contractor's License Law, Chapter -94 ommencing with Section _7000) of
Division 3 of the Business and Ptofessions Code, or .that. he is- exempt. therefrom, - and the basis
for the allege. exemption. Any,
d'Section. 7031.5 'any for
Plan. Chk. Dep.
_
- violation of by applicant. a permit
' subjects the applicant to a civil penalty of not more than rive hundred dollars.($500). • "-j
Plan Chk. Bal.'
a
,. ❑ I, as owrier,of the property, or my employees with wages as their sole compensation, will • ,
.,
do the.work,.and the structure isnot Intended'or offered for sale. (Sec. 7044; Buisness andC_
Of1St.'
$ m u
Profess ions. Code: The Contractor's License Law does:not apply.. to an owner. of property who
builds or improvesthereon' and who does such work -himself or .through his own, employees,,..
Mech.`-
• '
•provided thafsuch improvements are. not Intended.oroffered for sale. If, "however;",the. building; - •.
or Improvement is sold within'one year of -completion; the owner -builder will have the: burden
Electrical
of proving that he did.not buildor improve for the purpose of sale.)
b' 1, as owner of the property; am'exclusively contracting with.licensed contractors to con-
Plumbing
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) (caned pursuant to the Contractor's License Law.)
. S.M.I.
"Grading
.. • �:
:
,
-.❑ I am exempt under Sec • B. Li P.C..for this reason
Driveway Enc.
Date Owner
Infrastructure
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: (Seca 3800, LaborCode.)
! -
Polic Company
'
Copy is filed with the city, ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF.EXEMPTION FROM
- -WORKERS' COMPENSATION INSURANCE
"REMARKS
Z . i j 01 �-
• ' (This section need 'not be completed If -the permitis for .one hundred dollars -($100) • valuation-
- - ...
(•.
V
{Y
or less.)
I certify that in the performance of the work for'which this permit is.issued, I shall not
✓ a
employ any person in -any mannered as to become subject to the Workers' Compensation.
Laws of Cali ornia.
�` L
ly
Date Owner
4 f
NOTICE, TO APPLICANT:_ ff, after making this. Certificate of."Exemption' you. should, become
". -ZONE: ' '
-" BY: - Y
subject to the Workers' Compensation. provisions of the Labor Code, you must forthwith.
comply with such provisions or this permit shall be deemed revoked. • -
- Minimum Setback. Distances: '. •. - ': - -
•
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSAT.IONCOVERAGE ISUNLAWF.UL;'AND•
-Side Street from Center. Line '
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND' CIVIL FINES UP TO ONE,
-Setback
r
•; HUNDRED THOUSAND DOLLARS ($100,000);1N ADDITION TO THE COST OF COMPENSATION, ':
Side Setback from Property Line
DAMAGES AS PROVIDED •FOR IN 'SECTION 3706 OF THE LABOR. CODE,' INTEREST, AND
ATTORNEYS
ATTORNEYS FEES.. '
This Is a building. permit when properly filled out, -signed and validated, and is subject to
FINAL- DATE
.•
INSPECTOR
,
expiration it work thereunder is suspended for 180 days:'
. I certify that.I have. read this application and state that the above information ls.correct?
;::-.Issued by:
Date'' 'Permit
I agree to comply with all city and •county ordinances and state laws relating•to.building '
4 '
construction, and hereby authorize- representatives of. this city to: enter•.the ,abo4a.
mentioned property for in purposes.
: Validated by:
Signature of applicant Date '
Mailing Address
Validation;
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIWU FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT.
POWER OUTLET
ROOF DRAINS
CARP. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. Ff.
OTHER APP./EOUIP.
DRINKING FOUNTAIN.
SO. FT. a
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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
UNDERGROUND
A.C. UNIT.
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING.
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL