13996 (SFD)-4 44 Q(4
P.O. BOX 1504
Building 44-610' N. Harland Dr78-105 CALLE ESTADO
Address LA OUINTA, CALIFORNIA 92253
Owner
No. 13996
Acacia Construction
Mailing BUILDING: TYPE CONST. VN OCC:_GRP. R3
Address 8141 B. Kaiser Blvd. 0 310604--231-014
A.P. Number
City Zip Tel.
AnaheimLoi, 18 Tract 23268 PhamAnaheim92308 1014)282-5800 Legal Description
ContractorSFD Plan C
Same Acacia Description
Acacia
Address _
t£ Classjf. B-1 293954 I Lic. # 1612
- -Arch. Engr., - _
Designer DC Design
Address Irvine Ave. (714) 641-1505
City Zip State
Santa Anaeights 92 0. #
LICENSED CONTRACTOR'S DECLARATION
I herebyy ofjjii that I,am licensed under provisions of Chapter (commencing with Section
000) of Di'( ion of the Business arM•Profeasions Code, and my license is in fu fgrce tSnd
affect. YI.J a/1
SIGNATURE DATE
-
OWNER•BU DER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason;' (Sec. 7031.5,Buslness grid P
m
/e
asons Code: Any ctty or county which requires a
permit to construct, atter, Improve, demolish, or repair any structure, prior to tta Issuance also
requires Me applicant -for such permtt' fo Ills a signed statement "that he is licensed pursuant to
the provisions of the Contractor's Llcenae: Law, Chapter 9 .(commencing w�Th Section 7000) of
Division 3 o/'the 8usIneas and Prolesslons Code, or then he is exempt therefrom, and the basis
for the alleged exempton. Any violation o/ Section 7031.5 by any app/leant for a permit
subjects the applicant to a civil panalfyol not.more than five hundred dollars (S500).
❑ 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 o/ property who
builds or improves thereon and who does such work himself .or through his own employees,
provided that such improvements are not intended of offered for sale. I/, however, the building
or improvement Is sold within one year o/ completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose o/ sale.)
0 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.)
❑ I 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 `mpensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy' 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 it the permit is for one hundred dollars ($100) 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: 11, after making this Certificate o1 Exemption you should become
subject to the Workers' Compensation provisions o/ the Labor Code, youmust 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 Addresa
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 l 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
ateMailing Address
City, State, Zip
ZONE: BY:
Minimum Setback Distances:
Front Setback fro n Line
Rear Setback f ar Pr ne
Side Street Se fro t r LI
Side Setbac m l?Merty L
FINAL DATE /A- I
Issued by:
Validated by:
Validation:
Sq. Ft. 15.91 No.
Size - - Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$98,465.00
PERMIT
AMOUNT .
Plan Chk. Dep.
Plan Chk. Bal.
536.78
Const.
635.00
Mech.
55.50
Electrical
131.49
Plumbing
144.00
S.M.L.
9.84
Gradig
20.00
Driveway Enc.
^0 -
Infrastructure
2215.02 -
TOTAL
3747.63
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback fro n Line
Rear Setback f ar Pr ne
Side Street Se fro t r LI
Side Setbac m l?Merty L
FINAL DATE /A- I
Issued by:
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES NO. PLUMBING FEES
1ST FL. SO. FT. ® a
2ND FL. SO. FT. 0
POR. SO. FT.
GAR. SO. FT. ®
CAR P- I SO. FT.
WALL SO. FT.
SO FT -@
ESTIMATED CONSTRUCTION VALUATION $
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC. BAR SINK
POWER OUTLET ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL -
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.
SO. FT. @-c BATH TUB
SO. FT. ® c WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID a 1% c SEWAGE DISPOSAL
SO.FT.GAR ® 3Ac 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
LAR
,AREA
AGE TANK
;STORAGE
R APPJEOUIP.
E