13999 (SFD)Building
Address
4
P.O. BOX 1504
78-105 CALLE ESTADO
44-670 H. Harland Dr LA QUINTA, CALIFORNIA 92253
No. 23999
-- _. Acacia Construction TVN R3
Mailing
BUILDING: TYPE CONST. OCC. GRP.-
Address 8141 E. Kaiser Elee1. 0 310A.P. Number 604-231-017
city Zip Tel. Lot 15 Tract 23268 Phase -3
-
Anaheim 92808 (714) 282-5800 Legal Description
Contractor Project Description SPID Plan C
Same Acacia
State Lic. City
& Classif. E-1 293,954 Lic. # 16i2
PSC Design
Address Tel. _
20351 Irvine Ave. (714) 641--1505
City lZip State
Santa Ana Eei hts 92707 Lic. #
LICENSED CONTRACTOR'S DECLARATION
JI hereb a that I am licensed under provisions of Chapter 9 (commencing with Section
of isr 3 of the Business and Professions Code, and my license Is in.full force and
attest. > 2 q .• qy
&GNATURE - DATE
OWNER.B &DER DECLARATION
1 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,after, improve; demolish, or repair any -structure, prior to its Issuance also
. requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the'140 ions of the Contractor's 5cense Law, Chapter 9 (commencing with Section 7000) of
Division 3 cf ilie Business and Professions Cade, or that. he Is exempt. therefrom, and the basis
for the aRegad exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than fhre hundred dollars ($500).
❑ 1, 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 improvementis sold within one year of completion, the owner -builder will have the burden
of proving, that he dict not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensedcontractors 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 Low.)
❑ 1 am exempt under Sec B. 8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I here y affirm that I have a certificate of consent to self -insure, or a certificate of
Worker' mpensation Insurance, oracertifled copy thereof. (Sec. 3800, Labor Code.)
Pol company
ET Copy Is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This sedan - need not be completed 11 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 sol as to become subject to the Workers' Compensation
Laws of Califomia.
Date Owner
NOTICE TO. APPLICANT. K, 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
Ihereby.afflrm 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 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
Sq. Ft. 1591 No.
Size Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$98,445.00
PERMIT
AMOUNT'
Plan Chk. Dep.
Plan Chk. Bal.
536.78
Const:
635.00
Mech.
55.50
Electrical
331.49
Plumbing .
144..00
S.M.I.
Grading
20.00
Driveway Enc.
—0—
Infrastructure
2215.02
TOTAL
$ 7•
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Pr Ine
Side Street Setback fro Titer '
Side Setback from Pro Li
FINAL DATE INS TO 99
Issued by: Date r t.119
I -Y94
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT. 0
BO NG
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
SEWER O114
4H),
ROUGH WIRING
GAR. SQ, FT, ®
U POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. SQ. FT.
LOOP
WALL SQ. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN.
GAS (FIN
URINAL
SQ F7 ®
ESTIMATED CONSTRUCTION VALUATION S
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
BOND BEAM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
=S
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FRAMING
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, a c
BATH TUB
FIREPLACE
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% 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
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ,WICTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH P
BO NG
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER O114
4H),
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS OUMETER
LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FIN
TEMP. POLE
GROUT
WATE HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus -)(t
=S
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING t7
�f/fj1�%
r
o
Lfes'
REMARKS:
VENTILATION
FIRE ZONE ROOFING -
FIREPLACE
SPARK ARRESTOR.
GAR. FIREWALL ('
LAING
MESH
INSULATIONISOUND / 71w
FINISH GRADING
FINAL INSPECTION ZZ
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL