14000 (SFD)P.O. BOX 1504 N o . 14000
Building 7&105 CALLE ESTADO
Address 44-690 I(. Harland Dr LA OUINTA, CALIFORNIA 92253
Owner
Acacia Construction
Mailing BUILDING: TYPE CONST. V-14 OCC GRP. R3
Address 8141 E. wiser Blvd. 0 310 A.P. Number 604-231-018
City Zip Tel.
Anaheim 92808 (714) 282-580Legal Description Lot 1.4 Tract 23268 Phase 3
Contractor Project Description SFD Plan A
Same ACBClA
Artrlross
State Lic. City
& Classif. Bbl 293954 Lic. # 1612
Arch.; Engr:,- - -
Designer IDC Design
Address Tel.
20351 Irvine Ave. 014) 641-1
City�+ p State
Santa Ana B Zi4.Cjhts 9270 ic. #
LICENSED CONTRACTOR'S DECLARATION
I herebt�on3
rm that I am licensed under provisions of Chapter 9 (commencing with Section
17000) of ofthe Busines4 and Professions Code, and my licen{s•�e Is in full forceeffect. � �...- C "rl 12.!?1\. "iT1.� 1SIGNACTURDATE
OWNER -BUILDER DECLARATION
I hereby affirm that.l am exempt from the Contractors License Law for the: following
reason: (Sec. 7031.5;Business and Professions Code: Any city or county wh/dn requires a
permit to construct; -alter, 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 0censed purauant to
.the provisions of the Contractor's License Law, Chapter 9 (conunermft 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 penaftyof not more than five hundred dollars ($500).
❑ I,:as owner of the property, or my employees with wages as their sole compensation, will
do themork, 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 safe. H, however, the building
or improvement is sold within one year of compistion, the owner -budder 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,andProfessions Code: The Contractor's License Law
does notapply to an owner of property who builds or Improves thereon, and who contracts for
,such proJecis.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-Insurs.,or a.certificate of
Workers mpensation Insurance, or a certified copy thereof. (Sec. 3800. Labor Code.)
Poll
cy Company
dl�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 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: If, after making this Certificate of Exemption you shouts became
subject to the Workers' Compensation provisions of the tabor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the pertorrnance 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
1 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
U --
Sq. Ft. No. No. Dw.
Size 1400 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition O
stimated Valuation $84,840.00
PERMIT
AMOUNT
Plan Chk. Dep:
Plan Chk. Bal.
fi .!5 6
Const._
572.00
Mech.
4 T7TO—
Electrical
117.30
Plumbing
144.00
S.M.I.
0.48
Grading
20.00
Driveway Enc.
—0—
Infrastructure
190f3. 90
TOTAL
0
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Ce er Line
Side Setback from Property e
FINAL DATE INSPECT
i
Issued by: I Date r Pip
Validated by:
I -y.91 i
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
r
YARD SPKLR SYSTEM.
2ND FL. SQ. FT. @
HEATING (ROUGH)
STORAGE.TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROOK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
TEMP. POLE
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WALL SQ. FT.
SERVICE
DRINKING FOUNTAIN
SQ FT ®
BOND BEAM
URINAL
ESTIMATED CONSTRUCTION VALUATION E
—417
C
FINAL INSP. 7
WATER PIPING
NOTE: Not to be used as property tax valuation
LUMBER GR:
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID a 11h 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 ELECTRICAL ' HEATING & AIR GOND. SOLAR
204
SETBACK
GROUND PLUMBING
UNDERGROUND
A'.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE.TANK
FORMS
SEWER O 01141
ROUGH WIRING
DUCT WORK
ROOK STORAGE
FOUND. REINF.
REINF. STEEL
GAS (ROUGfilf /
GAS (FINAL)
METER LOOP
TEMP. POLE
HEATING (FINAL)
OTHER APPJEQUIP.
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL. INSP.
—417
C
FINAL INSP. 7
7
GRADING
cu. yd.
$ —Plus—x$—=$
LUMBER GR:
FRAMING / 9
ROOFING/ �O
`
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LA HING
MESH
INSULATIONISOUND 1
FINISH GRADING
FINAL INSPECTION L7j
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL