13380 (SFD)P.O. BOX 1504 No.
Building 78-745 Irwin Cirele LA QUI 105 CEESTADO
CALIFORNIA 92253
Address
V W I ICI Ac&cia Construction
Address $141 E. Kaiser Blvd. #3.14
City ZipTel.
Analheim# CA 9280 (710282-580-1
Contractor
Sam
Address
13380
11LDING: TYPE CONST. VN OCC: GRP. R3
P. Number 644-232-021
gal Description Lot 150 Tract 23268 Phase 2
oject Description SFD Plan C
Acacia Homes
City Zip Tel
State Lic.-City
& Classif. �' 2939�J Lic. # 1- Sq. Ft. 1591 No. No. Dw.
Size Stories Units
Arch.; Engr.; -
Desigen�esr DC Desi4n New ❑ Add ❑ Alter ❑ � Repair ❑ -' Demolition ❑
Addjej ,,, Irvine Ave. _[7e"'_(71411
e"'}4y 6411-150.
City Zip St�l e
sant . ��s Re ghts, CA 91L• ic.87
/ LICENSED CONTRACTOR'S DECLARATION
I hereby affirm thaO am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full -force and
effect. /A A,/ II_
1> r/%_
ff`SlGNATURE I � i fig / DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,8usiness 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 statemeni'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.)
O I, as owner of the property, am exclusively contracting witti 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 contractors) licensed pursuant to the Contractor's License Law.)
O 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 N�-!0 Company
❑fCopy 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 ($100) valuation
or less.) -
I certify that in the performance of th? 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
i 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 Address
City, State, Zip
TOTAL j I j J r 6L3. $U
REMARKS
j'
N
t
ZONE: BY: v
Minimum Setback Distances:
Front Set ack 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:
Estimated Valuation
$94#-649.00
PERMIT
AMOUNT'
Plan Chk. Dep.
Plan Chk. Bal.
521.02
Const.
612.50
Mech.
55.50
Electrical
131.49
Plumbing
144.00
.S.M.I.
9.50
Grading
20.00
Driveway Enc.
.00
Infrastructure
2,129.59
TOTAL j I j J r 6L3. $U
REMARKS
j'
N
t
ZONE: BY: v
Minimum Setback Distances:
Front Set ack 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. SO. FT. ® $
UNITS
� �
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. 4 SO. FT.
HEATING (ROUGH)
POR. SO. FT. @MOBILEHOME
SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCTWORK
DRAINAGE PIPING
CAR P. SO. FT. ®
vj
`
GAS (ROUGH) !Lop 4 METER LOOP
/
WALL SO. FT.
HEATING (FINAL)
DRINKING FOUNTAIN.
SO. FT. ®
REINF. STEEL
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATE SERVICE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FRAMING
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
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
SO.FT.GAR ® 3Ac
HOUSE SEWER
GAR. FIREWALL
LATHING 47/
MESH
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 ELE RICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING17
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER ROUGH WIRING
DUCTWORK
ROCKSTORAGE
FOUND. REINF.
n
vj
`
GAS (ROUGH) !Lop 4 METER LOOP
/
HEATING (FINAL)
OTHER APPJEGUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATE SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
2 Q
GRADING
cu. yd.
$ plus
x$ -$
LUMBER GR.
FRAMING
ROOFING_
VENTILATION
(��I"(J
j
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 47/
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL