14012 (SFD)Building
Address 44-790 NOrth Har
Ower
�caci.a Con3t:Uetion
u
P.O. BOX 1504
78-105 CALLE ESTADO
n&1 n ri:rP LA QUINTA, CALIFORNIA 92253
Mailin
Address 5141 E, Kaiser Blvd. 0310
City ZipTel.
Anaheim 92808 14-•282 -5500
Contractor
Same
Address
ty
State Lic. I City
& Classif. 293954 Lic. # 1612
Arch:, Engr , -
Designer . D Design
AddyGGal-351 Irvine Ave. Tel 7114-64;1-1505
CityZip State
,'Santa Ana.,Heig s 92707 Lic.;#
L(CEN CONTRACTOR'S DECLARATION
I hereby afflrrrl that I am licensed under provisions of Chapter 9 (commencing with Section
za000) of Di��ri�8 n'3 of,the Business and Rmfessions Code, and my license is in full force and
e ct. Sl
SIGNATURE DATE
OWNER-BUILbER DECLARATION'
I hereby affirm that,I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031:5,116siDess and Professions Code: Any city or county which requires a
permit to constrict; atter, improm- demolish, or repair any stricture, prior to fits Issuance also
repo/res the applicant for such permit to -ills 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 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.cldl penally of not more than five hundreddollars (E500).
❑ I, as owner of,the property; or my employees with wages as their sole compensation, will
do the work, and the%tructureas 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. fi, however, the bulldmg
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.)
❑ 1, as ownerof=the property, am exclusively contracting with licensed contractors to con-
struct
oo-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 oordractor(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 Compensation Insurance, ora certified, copy thereof. (Sec. 3800, Labor Code.)
Policyy�,,,s Company
lsJ"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.)
1 certify that in the performance of the work for which this permit is Issued, I shall not
employ any ppeerson in any manner so as to become subject to the Workers' Compensation
Laws of Cal if
Date Owner
NOTICE TO APPLICANT: d, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply wlth,such provisions or this perk 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.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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
WN
BUILDING: TYPE CONST.
A.P. Number 6041-231-023
Pio. 140.2
OCC: GRP. R3
Legal Description Lot .9 Tract 2326' Phase 3 .- .
Project Description
Sib: Plan C-
Acacia
ZONE: BY: _— - '�� ' v
Minimum Setback Distances:
Front Setback from Cen eAyne
Rear Setback from Rear PFFIP
Side Street Setback from Center Line
Side.Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft. No.
Size 1591 Stories
No. Dw.
Units
New IN Add ❑ Alter ❑
Repair ❑ Demolition p
Estimated Valuation 98,,.445.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
536.75
Const.
635.00
Mech.
55.50
Electrical
131.49.
Plumbing
144.00
S.M.I.
9.54 .
Grading
20.00
Driveway Enc.
Infrastructure
2215.02
TOTAL
3747.63
REMARKS
ZONE: BY: _— - '�� ' v
Minimum Setback Distances:
Front Setback from Cen eAyne
Rear Setback from Rear PFFIP
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
COLL. AREA
SLAB GRADE
ROUGH PLUMB., -'**-BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS 0
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (FINAL)
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN,
SO FT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
P
LAUNDRY'TRAY
AIR HANDLING UNIT CFM
REMARKS:
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
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR.® 3Ac
HOUSE SEWER
MESH
INSULATIONISOUND /
FINISH GRADING
FINAL INSPECTION
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
FORMS 0
SEWER
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REIN F. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
FINAL INSP. (f
FRAMING
FINAL INSP.
ROOFING
VENTILATION
P
/ vj
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
- GAR. FIREWALL
LAT ING / �J
MESH
INSULATIONISOUND /
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL