13377 (SFD)Building
T4ht 4 4 QN
P.O. BOX 1504
78-105 CALLE ESTADO
ar.,A n,..4 %r,=I-A QUINTA, CALIFORNIA 92253
Owner Acacia Construction I
Address 8141 E. Kaiser Blvd. 0310
City -
Zip Tel.
Anaheim, CA 92808 1010282-S800
Contractor
Same
Address
State Lic. B_1 293954
& Classif.
Arch., Engr., n DC Design
g
Ac'` `t a1 IrVine AVe.
No. 13377
BUILDING: TYPE CONST. V14 OCC: GRP. R3
A.P. Number 604-231-021
Legal Description SFD Plan E
Project Description -Lot 12 Tract 23268 Wise 3
Amaiganomes
pity1612
Lic. # Sq. Ft. 2358 No. No. Dw.
Size Stories Units
T;l�143 641-1505
Cit
�anta '_Ana Hel ;pts, CA 92 in
LICENSED CONTRACTOR'S DECLARATION
1 herb affirm that l.am licensed under provisions of Chapter 9 (commencing with Section
e000) of n 3 of the.Business a Professions Code, and my license lm full force and
ffect.. 2. S
r..�
NA TE
OWNER•BUI DER DECLARATION
I hereby affirm,that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5, Business and Professions Code: Any city orcountywhich requires a
permit to construct, e/ter, Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Nle a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter B (commencing with Section 7000) of
Division _3 of the,Biisk!ess and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged.,exemptlon. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to'a civil penalty of not more than rive 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 Inlproveinents 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 ne.did not build or Improve for the purpose of sale.)
Q 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 withe contractor(s) licensed pursuant to. the Contractor's. License Law.).
Q 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
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
PolicyCompany
Q Copy is filed with the city. Q 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 thQ work for which this permit is issued, I shall not
=anyperson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date ,Owner
NOTICE TO APPLICANT: N, 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 affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3087, 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
New [X Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Estimated Valuation $1411013.00
IPERMIT I I AMOUNT`
Plan Chk. Deg
Plan Chk. Bal.
Const.
Mech.
Electrical
S.M.I.
Grading
Driveway Enc.
Infrastructure 3174.15
TOTAL 5iu _3
REMARKS Ji 11 �
ZONE: 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
A.C. UNIT
F`
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL SQ. FT.
ROUGH PLUMB.
BONDING
MOBILEHOME SVC.
BAR SINK'
POR. SQ. FT. ®
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
ROCK STORAGE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GAS (ROUGH)
WALL SQ. FT. '@
HEATING (FINAL)
DRINKING FOUNTAIN.
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
-
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM, FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER ' .
BOND BEAM
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID a 11h c.
SEWAGE DISPOSAL
SQ.FT.GAR ® 3Ac
HOUSE SEWER
SPARK -ARRESTOR
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
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMSIt
SEWER OR
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF,
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINA
b
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. Q
GRADING
cu. yd.
$, plus xS
=$
LUMBER GR.
/
FRAMING Z 6 SGi
III
FINAL INSP.
ROOFING
VENTILATION
PIP
// ��
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK -ARRESTOR
GAR. FIREW LL
LA INF �f
MESH
INSULATION/SOUND f'
FINISH GRADING
FINAL INSPECTION f07
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS-
GARDEN WALL FINAL