14001 (SFD)B'Id'
T-4ht 4
u
P.O. BOX 1504
U
Ing 78-105 CALLE ESTADO
Address 44-718 Na Marland Dr LA QUINTA, CALIFORNIA 92253
Owner Acacia Construction
Address 8141 U. Kaiser Blvd. 0 3.10
City Zip Tel..
Anaheim 1 9280$ 01+4) 282-580
State Lic. City
& Classif. B-1 293954 tic. # 1612
Arch.; Engr:,..
Designer DC Design
AddrT635-1 gru.i:ne Ave T614) 641-150
citySanta 'Ani H Sights 9274 L;cta
LICENSED CONTRACTOR'S DECLARATION
hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
of D n 3,of;the Business and Professions Code, and my license Is in full forcean
ffact.
DATE
OWNER-BUYLDER DECLARATION
I hereby affirfn that I am exempt from the Contractor's License Law for the following
reason: (See. 7031.5,Busbtess and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demollh, 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 provklons of,the Contractor's License Law, Chapter 9 (commencing - with Section 7000) of
0lvislon 9 ol,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).
0 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, Suisness 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. fl, however, the building
or Improvement is sold within one, year of completion, the owner -builder will have the burden
of proving that'he dM not build or Improve for the purpose of sale.)
❑ I, as ownerof the property, am exclusively contracting with licensed contractors to con-
struct the project.. (Sec. 7044, Business and Professions Code: The Contractor's License taw
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.)
❑ 1 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
Workers 96moonsation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Polic o.�Company
0 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. ff, 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 Pettit 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, CNN Code.)
Lenders Name
Lenders Address
This is abuilding pernit,when,properly filled out, signed and validated, and is subject to
expiration if work1hereunder is suspended for 180 days.
I certify that I have read tfils,,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
No. 14001
BUILDING: TYPE CONST: V`# -,.—OCC: : GRP. • R3
A.P. Number 604-231-019
Legal Description Lot 1.3 Tract 23268 Phase 3
Project Description Si' D Plan C
Acacia
Ft. No.
e 1591 Storif
No. Dw.
Units
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation $98,445.40
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
536.78
Const.
635.00
Mech.
55.5
Electrical
131.49
Plumbing
144.00
S.M.I.
9.64
Grading
20.00
Driveway Enc.
—0—
Infrastructure
2215.02
TOTAL
•
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Cen ne
Rear Setback from Re P.
ide Street Setback Feentpxw�
/Side Setback from . rty Line
i ��(`
FINAL DATE / SPECTORP r+
l A_ .9 _ n
Issued by; f
Validated by:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO: PLUMBING FEES
1ST FL. SQ. FT. ® E
UNITS
2ND FL. SO. FT.
COLL. AREA
YARD SPKLR SYSTEM
:ladyROUGH
MOBILEHOMESVC.
BAR SINK
POR. SO. FT. ®
HEATING (ROUGH)
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
SEWERROUGH
DRAINAGE PIPING
CAR P. SO. FT. ®
DUCT WORK
ROCK STORAGE
WALL SO. FT. ®
DRINKING FOUNTAIN_
SQ. FT ®
R LOOP
URINAL
ESTIMATED CONSTRUCTION VALUATION $
OTHER APP.IEQUIP.
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
WATER HEATER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
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.
SQ: FT. ® c
BATH TUB
""
�i�J /
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Ac
HOUSE SEWER
FIRE ZONE ROOFING
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
:ladyROUGH
PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
1
SEWERROUGH
WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
R LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF..STEEL
GAS'(FINAL)
TEMP. POLE
GROUT
WATER HEATER
f SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
RADING
cu. yd.
$ plus x3
=E
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
( �
""
�i�J /
� j i,/�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL !�
MESH
INSULATIONISOUND / Q
FINISH GRADING
FINAL INSPECTION
Awl
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL