12807 (PAT)Building
net
'Q'I
P.O. 1504
78-741 Wast Harland 78-105 CALOLE ESTADO
LA QUINTA, CALIFORNIA 92253
Acacia Construction
Maili
Address 3141 E. Kaiser Blvd. #310
City Zip - Tel.
Anaheim, CA 1 92808 (714) 282-'5600
same
City lZip
ate Lac. 293954Lolly 1612
Classif. I Lic. #
D".y, ., I
esigner
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that'LaA}licgnsed and provisions of Chapter 9 (commencing with Section
,70Q0) of Division 3 df ttie Bu#mess argd;,rofessions Code, and my license is In full force and
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason:. (Sec. 7031.5;Buslness and Professions Code: Any city or county which requires 'a
permit to construct, alter, 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 o/ 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 penally of not more than five hundreddollais (5500).
❑; I, as owner of the property, or my employees with wages as their sole compensation, will
do'
o the work, and-the"structure is not Intended or offered for sale. (Sec. 7044, 8uisness and
Professions Code: The Contractor's License Law does not apply to an owner o! 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. ff, however, the budding
or Improvement is sold within one year of completion, the owner -builder will have the burden
o/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, with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt, under Sec. B. ti 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 Compensatio .Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Polinv No. Company
& s filed with the city. ❑ Certified copy is hereby furnished.
6' CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if.the permit is for one. hundied dollars ($t00) valuation
or less:)
1 certify that in the performance'ofrth0 work for. -which this:permit is issued, I shall not
employ any parson in any manner.sorap to become'subject t0 -the Workers' Compensation
Laws of California. fy,�
Date Owner r' J
NOTICE TO APPLICANT: If, after making this Certificate of Exem`plibri 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, andis subject to
expiration if work thereunder is suspended for 180 days.
(,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. 12807
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number
Legal Description
Project Description Patio cover
Sq. Ft. 144
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
Estimated Valuation
$1,915.00
PERMIT -
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
29.25
Const.
45.00
Mech.
Electrical
Plumbing
S.M.I.
.50
Grading
Driveway Enc.
Infrastructure
TOTAL
. 7 4 .7 5
REMARKS
--
X661
T T.
ZONE: BY: i
Minimum Setback Distances:
Front Setback from Cent e ine
Rear Setback from Rear Prol p.Tim
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
I
t�
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ®_ $
UNITS
COLL. AREA
~
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT. �
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT.
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT..®
GAS (FINAL)
TEMP. POLE
WALL SO. FT. ®'
DRINKING FOUNTAIN -
GROUT
WATER HEATER
URINAL
SQ. FT. ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
_
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
$ plus x$
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
LAUNDRYTRAY
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
SO. FT. @.c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
MESH
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
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
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$
=Z
LUMBER GR.
FINAL INSP.
'FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING',
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIG NATO RE_Sll NITIALS
GARDEN WALL FINAL