14010 (SFD)Building
Address
' u
P.O. BOX 1504
78-105 CALLE ESTADO
44-770 Ilorth Narla d Drivd-A QUINTA, CALIFORNIA 92253
Mailin
Address8141 >w. Kaiser grid. #310
City ;Zip Tel.
Anaheim 92808 214 -Zea -5800
Contractor
same
State Lic. '
& Classif. 293954
Arch., Engr.;
Designer
Address 351
Zip Tel.
No. 14®1®
)ILDING: TYPE CONST. did OCC. GRP. R3
P. Number 604-231-022
:gal Description Lot 10 Tract 23268 Phase.3
oject Description ;AFD Plan H
Acacia
City
Lic. # 1612 Sq. Ft.
Size
.[Illi I New C�►
Irvine Ave. Tel.
714-64I--1545
CityZip State
Santa Ana Heigh S, 92%t37 Lic. #
LICENSED. CONTRACTOR'S DECLARATION .
I hereby a irm,that I am licensed under provisions of Chapter 9 (commencing,with Section
�i000) of D s 3 of the BusinessAnd Professions Code, and my license is in fulllorcepl
SIGNA IUR DATE
OWNER -B ILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031:5,Buslness and Professions Code: Any city or county which requires a
Zpermit to oonstr., alter, Improve, demollsh, or repair any structure, prior to Its issuance also
reyurres 'con
for such permit to file a signed statement that he Is licensed pursuant to
the provisions of the Contractor's License' Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis
for the ,alleged. exemption. Any violation of Section 7031.5 by any applicant for a permit
subjectsdhe applicant to a civil penalty,of not more than five hundred dollars (5500).
❑ 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 Improvements are not intended or offered for sale. H, however, the building
or Improvement is sold within one year of completion, the owner -builder 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 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 witha 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
Worker's C mpens ition Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Poli Company
'D Copy is filed with the city. ❑ Certified copy is hereby.fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N the permit is for one hundred dollar: ($100) valuation
or less.)
I certify, that in the performance of th¢ work for which this permit is Issued, I shall not
employ any pparson in any manner so as to become'subject to the Workers' Compensation
Laws of Califomla.
Data Owner
NOTICE TO APPLICANT. If, after making this Certificate or 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
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.)
Lenders Name
Lender's Address
This is a= permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 160 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
No.
No. Dw
Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
ZONE: BY: i
Minimum Setback Distances:
Front Setback from Center%T,jle
Rear Setback from Rear Prop -E -e
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
Estimated Valuation $1-00,442.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
544.48
Const.
643.00
Mech.
55.50.
Electrical
133.42
Plumbing
150.00/
S. M.I.
/
10.0 4
Grading
20.00
Driveway Enc.
Infrastructure
2259.94
Arts in Public! Places
20.00
TOTAL
1 3836.38
ZONE: BY: i
Minimum Setback Distances:
Front Setback from Center%T,jle
Rear Setback from Rear Prop -E -e
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
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
Cl
Y
ARD SPKLR SYSTEM
2ND FL. SO. FT. @
HEATING(ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING,(FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (FINA
WALL SO. FT.
TEMP. POLE
DRINKING FOUNTAIN.
SO FT 0
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
SERVICE
WATER PIPING
NOTE: Not to be used as proparty tax valuation
BOND BEAM
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
FRAMING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROOFING
VENTILATION
LAUNDRYTRAY
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.® 1 Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® Vac
HOUSE SEWER
GASPIPING
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
A
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
Cl
ROUGH PLUMB.
BONDING
HEATING(ROUGH)
STORAGE TANK
FORMS
SEWER
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING,(FINAL)
OTHER APP.1EOUIP.
REINF. STEEL
GAS (FINA
I�
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. d'
FRAMING
FINAL INSP.
ROOFING
VENTILATION
��
{(
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING r' f
MESH
INSULATION/SOUND f
FINISH GRADING
FINAL INSPECTION
(( V
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL