10762 (SFD)•
76S,
4
P.O. BOX 1504
Building 78-635 Forbes Circles 78-105 CALLE ESTADO
Or1lr1rPCC LA QUINTA, CALIFORNIA 92253
Owner
Acacia
Mailing -
Address 1021 Baytanchury Rd
City Zip Tel.
Fullerton 192633 1714/992-0880 Legal Description Lot 48 Tract 23256
Contractor Project Description. Plan C--3 Phase IIS
Acacia Const -ruction
No. 10762
WING: TYPE CONST. OCC: GRP.
P. Number
Address.
same
City Zip Tel.:
State Lic. I City
& Classif. B 293954 Lic' # 1612
Designer
Address Tel.
City Zip State
/r`r� Lic. #
LICENSED CONJ CTOR'S DECLARATION
I hereby affirm that I am licens d unde��rovisions of Chapter 9 (con
7000) of Division3lof the�Busin s andrProfes�ions Code, and my lice
effect: i/" /%/d✓/�n /r'6 ///'
OWNER -BUILDER DECLARATION " J •
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, alter, 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.)
❑ 1, 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.)
0 1 am exempt under Sec. B. & P.C. for this reason
Sq. Ft. 192 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
;timated Valuation 1 d —5, -013-3
._
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
66U. 50
Mech.
60.00
Electrical
114.47
Plumbing
.144.50
S.M.I.
7.42
Grading
Driveway Enc.
Date Owner I Infrastructure . A378 . 77
Afi Q
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
❑ 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
or less.)
I certify that in the performance of Ing 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 certify that I have iead 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
its in Ft,�� c
TOTAL •tfd
REMARKS
ZONE: ~ µ 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
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEOUIP.
DRAINAGE PIPING
CAR P. Q. Ft.
S
TEMP. POLE
WALL SQ. Fr.
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
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® t Vi c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3'ic
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
CERT. OCC.
FENCE FINAL
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
Pla5C3 Phase III
Z,
Q&
CITY OF LJ* OUINTA
DEPARTMENT OF PLANNING & DEVELOPMENT
BUILDING DIVISION
24-HOUR NOT94441411ftIONS
JUL z1199?_
Owner Acacia fINIM DUAAaWNf
Contractor Acacia Construction
Permit Numfmr 10762
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS
78-635 Forbes Circle
TYPE OF INSPECTION
DATE INSP.
FOUNDATION 8 SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL A OVE JAAS BEEN SIGNED
CONCRETE SLAB
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS 8 GAS TEST
HEATING 8 VENT- A/C
Ztoti
FIREPLACE
ROOF
J
tv ✓
SOND18EAM
O.K. TO WRAP n ..
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS B EN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE 8 GATE
SEWER SEPTIC TANK
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS4119-NeT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
4.88