10758 (SFD)P.O. BOX 1504
Building 78-600 Forbes; Circle78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Acacia
Mailing
BUILDING: TYPE CONST._
Address 1021 Ba5ts'3.nOi ury Rd A.P. Number
City Zip Tel
No. 10758
OCC: GRP.:
Fullerton 92633 714/992-08.80 Legal Description Lal 42 Tract 23258
ContractorPlan Phase III
A1:6cia Construction Project Description
Address.
same
State Lic.
& Classif. B 293954
Arch., Engr.,
Designer
Address
City
I hereby affirm
7000) of Dip�"6J'ibn
effect. P ') _
Lic. # 1612 rN
q. Ft.
ze
ew❑
Tet.
Zip (State
Lic. #
CONTRACTOR'S DECLARATION
fu_�:
.under Drovi ions of Chapter 9 (commencing with Section
andIT 01r ssilo s Code, and my license is in f411 forcg an
OWNER -BUILDER DECLARATION �' [
I hereby affirm that I am exempt from the Contractors 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) 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.)
Policy No. -Company
O Copy 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
orless.) -
1 certify that in the performance of thg work for which this permit is issued, I shall not
=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.)
Lenders 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
Stories
No. Dw.
Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
uat
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
-MW41:.: ,
Const.
'
Mech.
Electrical
AF41 /
ms's
Plumbing
S. M.I.
$—
Grading
Driveway Enc.
Infrastructure.,,
-W Alahl
TOTAL
REMARKS
Td '�.� if r°• /l � i- � t"• 'r' s f'" i`.,-'7�/' r ,'{ : i.'..”'
,f ZONE:' r ` 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
F
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SQ FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as properly tax valuation
FINAL INSP.
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
FIRE ZONE ROOFING
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
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. Fr. RESID ® 1 Vi c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3Ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
TNST. 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 APPJEOUIP.
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
Plan C2 Phase III
CITY OF LA OUINTA
°r or ^ DEPARTMENT OF PLANNING & DEVELOPMENT
BUILDING DIVISION
564-2246
24-HOUR NC0"IU f T i oNM%CTIONS
JUL z 1 1942
Owrw Acacia I r
Contractoros
Acacia Cnru �3'ii"
Pa., it Number 10758
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-600 Forbes Circle
TYPE OF INSPECTION
9ATE, INSP.
FOUNDATION 8 SETBACK
ROUGH PLUMBING
FOOTING STEEL
ROUGH GAS 8 GAS TEST
MAIN GROUND SYSTEM
HEATING 8 VENT -A/C
GROUND PLUMBING 4Z2
P �L
PRE-GUNITE
ROOF
DO NOT POUR CONCRETE UNTIL ALL A
OV HAS 0 EN SIGNED
CONCRETE SLAB
O.K. TO WRAP
JOISTS 8 GIRDERS
GROUT O 4' O 8'
FRAMING
ELECTRICAL GROUND WORK
INSULATIONi1/.,4_
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS 8 GAS TEST
0V
HEATING 8 VENT -A/C
FIREPLACE
ROOF
BOND BEAM
41
O.K. TO WRAP
TIC (
GROUT O 4' O 8'
FRAMING
L
INSULATIONi1/.,4_
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEFN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
1
POOL FENCE 8 GATE
SEWER SEPTIC TANK
v,p <%7 /h
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED A f A-2 fAA _
ABOVE APPROVALS DO-W3T INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
4!88