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10752 (SFD)P.O. BOX 1504 No. 10752 Building 78-105 CALLE ESTADO Address 78-605 Forbes Circle LA QUINTA, CALIFORNIA 92253 Owner Acacia Mailing BUILDING: TYPE CONST. OCC. GRP.- Address 1021 Bajstanchury Rd A.P. Number City Zip Tel. Fullerton 192633 1714/9912_0830 Legal Description Lot 45 Tract 23268 Contractor Project Description Plan Ay -3 Rey Phase. III Acacia Construction Address sanke City Zip Tela State Lic. City & Classif. B 293954 Lic. # 2612 Sq. Ft -L362 No. No. Dw. Arch., Engr., Size Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I ar�n licensed under provisions of Chapter 9 (commencing with Section„ 7000) of Divis�iic�ip 3 of the 4u9iness�and Professions Code, and my license is - '/(LII fore ander,/ effect. Y'7A1+(�,17��•ll "� �/�� SIGNATURE ' r" '�' 'DY1TE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following 74,631 � 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 AMOUNT requires the applicant for such permit to rile a signed statement that he is licensed pursuant to PERMIT the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 or the Business and Professions Code, or that. he is exempt therefrom, and the basis for the 7 alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep. l subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). . . 4.� • 3 01, as owner of the property, or my employees with wages as their sole compensation, will Plan ChkBBIC 3 3 4tl do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 5�7 . 00 0 v V 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, Mech. ! . (} y provided that such improvements are not intended or offered for sale. If, however, the building C y or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 90. 61 of proving that he did not build or improve for the purpose of sale.) i ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 120. 50 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 S.M.I. 5. 25 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - Grading O I am exempt under Sec. B. 8 P.C. for this reason Driveway Enc. Date Owner Infrastructure 1679. 19 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. O Certified copy is hereby furnished. TOTAL LyIU. t39 CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) e 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' Co... 1 / Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: LJ BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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.) Side Setback from Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR 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. Issued by: Date Permit 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. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINVEES 1ST FL. SO. FT. ® $ UNITS 1 ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. FORMS SEWER OR SEPTIC TANK POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS HEATING (FINAL) OTHER APPJEOUIP. DRAINAGE PIPING CAR P. I SO. FT. ® TEMP. POLE WALL SQ. FT. GROUT DRINKING FOUNTAIN. SQ FT ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation =$ FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER 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, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SO. FT. ® c. BATH TUB GAR. FIREWALL SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® V4c HOUSE SEWER 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 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 SIGNATURES/INITIALS GARDEN WALL FINAL Plan A3 Rev Phase III I CITY OF u OUINTA OF . DEPARTMENT OF PLANNING & DEVELOPMENT BUILDING DIVISION 5642246 24-HOUR NOfAff&,%W0jfRTIONS O>wfw Acacia JUL 199? Contractor Acacia Pwmk Number 10752 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 78-605 Forbes TYPE OF INSPECTION DATE INSP. FOUNDATION & SETBACK FOOTING STEEL Z MAIN GROUND SYSTEM GROUND PLUMBING F% DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGN -ED CONCRETE SLAB JOISTS & GIRDERS ELECTRICAL GROUND WORK DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS & GAS TEST HEATING & VENT- A/C FIREPLACE , ROOF �- BOND BEAM O.K. TO WRAP M— GROUT ❑ 4' ❑ 8' FRAMING , ' ,, r INSULATION PRE -ROOF COVER NO WORK UNTIL ABOVE H S BEEN SIGNED DRYWALL INTERIOR EXTERIOR LATH POOL PRE PLASTER POOL FENCE & GATE SEWER SEPTIC TANK � ELECTRICAL 0 2— (.-- PLUMBING FINAL GAS TEST HEATING - A/C HOUSE NUMBERS JOB COMPLETED G— ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING 4/88