12840 (SFD)4
P.O. BOX 1504 No. 12840
Building 78-105 CALLE ESTADO
Address 78-755 Irwin Cirole LA QUINTA, CALIFORNIA 92253
Owner +.
Acacia Construction
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 8141 E.. Kaiser .Blvd. #318 A.P. Number 684--232-422
City Zip Tel
Anaheim, CA 92888 (714) 282-5800 Legal Description Low 151. Tract 2326$
Contractor 1 SFA plan A
Pro'ect Description
Smite
Acacia Homes
Address
City
Zip
Tela
State Lic.,,1 2�3�54
& Classif.
City 1612
Lic. #
Sq. Ft. 1280 No. No. Dw.
Size Stories Units
Arch., Engr.,
Designer DC Design
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Ad11Vj!jJg Irvine A'Ve.
Tel.
(714) 641 150
457„61
lsanta, Ana HeLIP state
4 ht.s, CA 9IMWO
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I,am licensed under provisions of Chapter 9 (commencing with Section., .
D00) of Division 3 of the business and Professions Code, and my license`ja in full force and.
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, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation or Section 7031.5 by 'any applicant, for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (3500). ,
❑ 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(ownei 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 or property^who builds or improves thereon, and who contracts for
such projects with acontractor(s) licensed pursuant to the Contractor's License Law.) .
❑ 1 am exempt under Sec. B. & P.C. for this reason �t
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.)
PollN0. _- - Company - -.
cj
WC• .py is filed with the city. ❑ 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 (5100) 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 if work thereunder is suspended for 180 days. i.
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 Address
City, State, Zip
ZONE: BY: U v
Minimum Setback Distances: LB
'Front Setback from Cen&TI21i
Rear Setback from Rear Prop. LineIIf
Side Street Setback from Center Line If
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
—
I
e
Estimated Valuation
$75r314.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
457„61
Const.
531,58
Mech. ,
49.00
Electrical
117.30
Plumbing
144, 80
S.M.I.
7.60
Grading
20.00
Driveway Enc.
.00
Infrastructure
1,694.57 -
,694.57TOTAL
TOTAL
' 3t021.58
REMARKS-
r
r
2. R 100A 11
ZONE: BY: U v
Minimum Setback Distances: LB
'Front Setback from Cen&TI21i
Rear Setback from Rear Prop. LineIIf
Side Street Setback from Center Line If
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
—
I
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
L
r" h CV !+
HEATING (ROUGH)
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
SEWER ROUGH WIRING.
DUCT WORK
ROCK STORAGE
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. Q
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
DRAINAGE PIPING
CARP. SQ. FT. ®
_$
LUMBER GR.
WALL SQ. FT.
FRAMING G
DRINKING FOUNTAIN.
ROOFING 40 1�%(J
VENTILATION
URINAL
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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
GARDEN WALL FINAL
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
L
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.AqqV
GAS (ROUGH) l METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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. S
FRAMING G
FINAL INSP.
ROOFING 40 1�%(J
VENTILATION
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING /
MESH
If
INSULATIONISOUND�
FINISH GRADING
�7
FINAL INSPECTION al (/
CERT. IOCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL