12522 (SFD)Building
T4 at 4 4vu
P.O. BOX 1504
78-105 CALLE ESTADO
78765 West Harland LA QUINTA, CALIFORNIA 92253
Owner
Acacia Conatruction
Address 8141 E. Kaiser Blvd. #310
City Zip Tel.
Anaheim, CA 1 9280 1(714)282-5800
Acacia Construction
Address
state Lic. B-1 293954 (City 1612
& Classif. Lic. #
DC Design
IA�J!fg,ll Irvine Ave.
Cit lZip
4)641-1505
Sasha ':Ana Heilthts, CA 92PA7a
LICENSED CONTRACTOR'SDECLARATION,
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and ;Profession s�Code, and my license Is in full force and
effect. ` f. n ,✓�+
SIGNATURE J DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that l 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, atter,,. improve, demolish, or repair any stricture, prfo'r to Its issuance also
requires the applicant for such permit to the 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).
❑ I, as owner of the property, ormy employees with wages as their sole compensation, will
dodhe work, and the structure 1,, 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 not build or improve for the purpose of sale.)
❑ 1, 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).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, or a certified copy thereof. (Sec. 3800, Labor Code.)
Pol Icy,No. Company
❑-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 certify 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 Callfornia.
Date Owner
NOTICE TO APPLICANT. N, 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
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 lawsrelating 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. 12522
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 604-232--063
Legal Description Lot 132 tract 23268 Phase 1
Project Description 5FD Plan C
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 DA
Issued by
Validated
Validatior
Sq. Ft. 1591
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$94,6438.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
21.01
Const.
612.50
Mech.
Ss. so
Electrical
131.49
Plumbing
144.00
S.M.I.
9.50
Grading
20.00
Driveway Enc.
.00
Infrastructure
2,129.59
TOTAL
r
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 DA
Issued by
Validated
Validatior
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
'SLAB GRADEt
3 d&
YARD.SPKLR SYSTEM
2ND FL. SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT.
4_
GAS (FINAW
WALL SO. FT.
DRINKING FOUNTAIN,
SO. FT. a
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// &4(,
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SO..FT. @ c
BATH TUB
SPARK ARRESTOR
SO. FT. a c.
WATER HEATER
MAX. HEATER OUTPUT; B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LATHING
MESH
SO.FT.GAR ® 3/ic
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 Z
GROUND PLUMBING
ANDERGROUND
A.C. UNIT
COLL. AREA
'SLAB GRADEt
3 d&
--ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
etyr
SEAR
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) /f //_--METER
LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL r, )
4_
GAS (FINAW
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
- FINAL.INSP. �. i 9
FRAMING Ib ?
b?
FINAL INSP.
ROOFING// &4(,
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION, G�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIAL:S
GARDEN WALL FINAL
iftf - -
Wuinta
Bun*
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Bulldingl
"Code certifying that at the time of issuance this structure was In compliance with the various , 7
ordinances of the City regulating building construction or use. For the following:
BUILDING ADDRESS 78-765 West Harland
690, ciassificoilon Single Family Dwelling522
'Bldg. ftrmif No., 12
Group ''R3
'Fire Zone
_Type Construction VN use 'Zons SR
'Owner of 'Building -Acacia Construction,` 8141 E. KaiS er Blvd. 4310
Anaheim, CA City - Mark Harold
BY;
2
-5
Data; March 1994
;,Bwildlnq Official
FOOT 10 AVONS!"OVOUS PLAN