12460 (SFD)Building
Address
Tw�l 4 4& Q$,
P.O. BOX 1504
78-105 CALLE ESTADO
7$745 West Harland LA QUINTA, CALIFORNIA 92253
vw11c1 Acacia Construction
Mailing
Address 814-1 E. KaiserBlvd. #310
City Zip Tel.
Anaheim, CA 92808 -101411282-5800
Contractor
Acacia Construction
Zip
State Lic. B-1 293954 (City 1512
& Classif. Lic. #
Designer 9 DC Deeign
Adljyy .1 Irvine Ave. 1114) 641--1505
Cilgaa��, Ana Hei pits, CA 9 bal
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions,�Code, and my license 1s in full force and
effect. IL
SIGNATURE DATE
OWNER•BUILDER DECLARATION
1 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 oftheBusiness 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 eppUcant to a civil penalty of not more than five hundred dollars ($500).
❑ 1, 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. it, however, the building
or Improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did notbuild or improve for the purpose of sale.)
p 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 contractor(s) Lensed 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, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No, - Company
0 dpy is filed with the city. ❑ Certified copy is hereby furnished.
-{ CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit Is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person.in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: It, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code. you must forthwith
comply with such provisions or this pe MM shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that 1 have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-.
mentioned property for Inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No.
11LDING: TYPE CONST. OCC: GRP.:
P. Number 04-232-001
Description Lot 130 Tract 23268 ease 1
t Description SFS Plan A
Sq. Ft. No. No. Dw.
Size 12$i3 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $75,314.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan.Chk. Bal.
457.61
Const.
531.50
Mech.
49.00
Electrical
117.30
Plumbing
144.00
S.M.I.
7.60
Grading
20.00
Driveway Enc.
00
Infrastructure.
11.694.57
TOTAL
31021.58
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 INSPECTOR
Issued by:
Validated
Validation
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING,(ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT.
DUCTWORK
ROCK STORAGE
GAR. SQ. FT. ®
IPOWEROUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SQ. FT: ®
3
GAS (FINAL)
WALL SQ. FT. @
DRINKING FOUNTAIN.
SO FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER,PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ -Plus-x$-=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROOFING 9
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, 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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LATHING I_
SQ.FT.GAR 0 Yic
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTALIFEES
MICRO FEE
MECH.F,EE PL.CK.FEE
CONST. FEE ]ELECT.FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBINCI G
NNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB:
BONDING
HEATING,(ROUGH)
STORAGE TANK
FORMS
SEWERO
ROUGH WIRING
DUCTWORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) ah�
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL C
3
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-x$-=$
LUMBER GR.
FINAL INSP. 3 / /
FRAMING /
FINAL INSP.
ROOFING 9
REMARKS:
VENTILATION!
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING I_
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS'
GARDEN' WALL FINAL
1 3
j,
(11.1111 t t Oututa
made
jI
This Certiflc6fe, issued pursuant to the requirements of Section .306, of the Uniform Buildingo,'. .
!A !I
Code certifying that at the time of issuance this structure was In compliance with the various, 1!
ordinances of the City regulating building construction' or use. For the following: I j I,
I I' i ''
� a ! ! It
BUILDING ADDRESS 78.-745 West Harland
I
ii
Use ClaWficitlom, Single Family Dwelling -Bldg. Permit Ift 12460
p If
'
Oioup R-3TY Pa Construction i, NN Fire Zone Use Zone SR'
ner 'of uf�dinAcag,*'.cia Construction'
Ow8141 E. Kaiser Eilvd,. #310
Addr"'$
.Anaheim, CA 92808
City Mark Harold
By•,.
nl per= March 25, 1994
Building Official
POST In A Wi 6"WOUS PLAN Law
SWIM -
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