12513 (SFD)ing
Owner
14
P.O. BOX 1504
78-105 CALLE ESTADO
78-750 test Harland LA QUINTA, CALIFORNIA 92253
Acacia Construction
Address 5141 E. wiser Blvd.. #310
City Zip Tel.
Anaheim, CA 1 92808 1010282-5800
Acacia Construction
State Lic. 8-1 293954 (city
8� 1612
ClaSISssif. Lic. #
Arch., Engr., DC Design
Ad
Designer�r33Gl
Lt7l Irvine Ave,111-106641-1505
Cit Zip State
arta. Ana Hei hta � . CA 9� may
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am Ii:e sed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of'tfie
effect. Bull
send Poo?esslonCode, and my license Is in full force and
SIGNATURE _ - DATE
OWNER -BUILDER 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, .after, Improve; demolish, or repair any ,structure, prior to, Its Issuance also
requires the, applicant for such permit Yo file a signed statement that he is licensed pursuant to
the piovfslons%'ol. the Contractor's License Law, .Chapter 9 (commencing with Section 7000) of
DMsion-3,oI he Business and Professions Code, or that he is exempt therefrom, and the basis
lar, the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects �the appIkant to a civil penalty of not more than live hundred dollars ($500).
❑'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. (Seca 7044, Buisness and
'Professions Code: The Contractors 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 safe. N, however, the building
or Improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he dM 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, BusinessandProfessions 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.)
El I am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I he 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
IIT 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.) ''.at
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 If, atter 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 orthis permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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
4u
No. 12513
BUILDING: TYPE CONST. OCC: GRP.;
A.P. Number 604231-002
Legal Description Lot 30 Tract 23268 Phase 1
Project Description SFD Plan D
FINAL DA
Issued by
Validated
Validatior
N �!
Sq. Ft. 1835
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation ,
$107,763.00
PERMIT
AMOUNT
Plan Chk. Dep.
230.00
PlanChk. Bal.
-- 310.75
Const.
667.50
Mech.
55.50
Electrical
1413-41
Plumbing
138.00
S.M.I.
10.80
Grading
20.00
Driveway Enc.
00
Infrastructure
?, 4261.67
Arts in Public Places 25.00
TOTAL
4,042.63
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
FINAL DA
Issued by
Validated
Validatior
N �!
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE, ^L Gr
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. ®
GAS (FINAL) TEMP. POLE
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
WASH ER(AUTO)(DISH),
APPLIANCE DRYER
ROOFING�I_
VENTILATION
GARBAGE', DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
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..a c
BATH TUB
GAR. FIREWALL
SQ. FT:,® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ: FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SO.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 rY + %
GROUND PLUMBING ERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE, ^L Gr
ROUGH PLUM%B. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER K ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. 2 (
3
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APP.1EQUIP.
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. / 3/ %
FRAMING /
FINAL INSP.
ROOFING�I_
VENTILATION
/Y� l _/2' 3 I
qv
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL