12451 (SFD)■
T4ty� 4 4 QQ
P.O. BOX 1504
7&105 CALLS ESTADO
78-730 West Marland LA QUINTA, CALIFORNIA 92253
.,tatter Acacia Construction
Mailing 8143 E. Kai Ger Blvd. 0310
City Zip Tel.
Anaheim, - CA 92808 (710282-580
Contractor
Acacia Cons O. -Suction
Address
p
State Lic. B-1 293954 I
City 16512
& Classif. Lic. #
Arch., Engr., DC AeSi it
Designer g
Adl`yyi Irvine Ave. 1114) 641-1505
tcJl"�a AnaFieig'�, CA '�274I`itct#
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1, am licensedtirfder provislons of Chapter 9 (commencing with Section
700 of Division 3 of the Business aaQ P�rof.�salons� J;aaFld friy license Is in full forceand
effect. I ,
SIGNATURE DATE
OWNER•13UILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5;Business and Professions Code: Any city or county which requires- a
permit to construct, atter, 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 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 civil penalty of not more than five hundred dollars ($500).
0 1, as owner,pf;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
buildsi. or_ bopioves� "thereon and who does such work himself or through his own employees,
provided thsVsuch improvements are not intended or offered for sale. B, however, the building
or Improvement Is sold within one year of completion, the owner -bulkier will have the burden
of proving that he dict 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 ipply to an owner of property who builds or Improves thereon. and who contracts for
such projects' with a contractor(s)'dicansed pursuant to the Contractor's License Law.)
O f am exempt under Sec. B. & P.C. tot 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.)
Policy.No` Company
6 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 certlfy'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 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.)
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.
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
Av'
No. 12451
JILDING: TYPE CONST. OCC. GRP.
P. Number 604-222-002
Legal Description
Project Description
Lot 32 Tract
$FD Plan B
23260 Phase 1
Sq. Ft.
Size 1596
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$96,547.00
PERMIT
AMOUNT
Plan Chk. Dep.
250.00
Plan Chk. Bal.
232.32
Const.
626.00
Mech.
55.30
Electrical
133.42
Plumbing
150.00
S.M.I.
9.70
Grading
20.00
Driveway Enc.
.00'.
Infrastructure
2,172.10
TOTAL
3,699.24
1 3,449.24
REMARKS
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 I
Issued by: Date
Validated by:
as
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
7i
ROUGH PLUM BONDING
so
YARD. SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
SEWER K ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH) / ,%/ METER LOOP
r /
HEATING (FINAL)
GAR. SQ. FT_ ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL) TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
WATER 'HEATER SERVICE
WALL SQ. FT.
DRINKING FOUNTAIN,
WATER SYSTEM
URINAL
SQ FT ®
LUMBER GR. FINAL INSP. /h/A/41
FRAMING 3 FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
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(AUTOADISH)
APPLIANCE DRYER
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.
SO. FT. ® c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT.,RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
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 COND. SOLAR
SETBACK (
GROUND PLUMBING (4ym6ERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
7i
ROUGH PLUM BONDING
so
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER K ROUGH WIRING
DUCT WORK
ROCK STORAGE.
FOUND. REINF. ?l
GAS (ROUGH) / ,%/ METER LOOP
r /
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER 'HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR. FINAL INSP. /h/A/41
FRAMING 3 FINAL INSP.
ROOFING 2 �3
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
• GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND 7#
FINISH GRADING
FINAL INSPECTION r
CERT. OCC.
rcurc ciuM
� 11;000
/
A
REMARKS:
INSPECTOR'S SIGNATURESIINITIALS'
GARDEN WALL FINAL