12461 (SFD)Building
Address
T4tyl 4 4v Q%'
P.O. BOX 1504
78-105 CALLE ESTADO
78-775 Fest Harland LA QUINTA, CALIFORNIA 92253
vMwf Acacia Construction
Mailing
Address 8141.E. Kaiser Blvd. #310
City Zip Tel.
Anaheim, CA 92G09 (714}282-5900
Contractor
Acacia Construction
Tel.'
State LiaH-1 293954 (city 1612
& Classif. Lic. #
ArchDes g ergs, CC Design
AVVejti Irvine Ave. 1114) 641-1505
cl9anta Ana Hei Ats, CA ,92P. -k
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed underprovisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my licenswis in full force and
effect. /_ /f7
,
SIGNATURE )P,V °�`�!� - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I em exempt from the Contractors License Law for the following
reason:�(Sec.`..7031.5;BUSInass and Prolesstons Code: Any city orcrounty which requires a
-pa
_ ro, sotrstiuct,. alter, Improve, demolish, or repair any structure. ,prior to its Issuance also
requires the applicant. for such permit tb gle a signed statement that he is licensed pursuant to
rMe:provlsionsolthe. Contractor's License Lew, Chapter 9 (commencing with Sectron 7000) of
.Dhiisffin:3 o/'the' &illness and Professions Code, or that. he is exempt there/rom, and the basis
tor= file alleged' exemption. Any violation of Section 7031.5 by 'any applkant for a permit
-sut>%ects the'applkant to a civil penalty o/not more than /Iva hundred dollars fE500).
0 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. (Sec. 7044, Suisness and
Prolesstons 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. N, however, the building
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 projectswith a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I 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 certified copy thereof. (Sec. 3800, Labor Code.)
Policy No: Company
P,Cdppy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i/ 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 parson in any manner so as to become subject to the it
Compensation
Laws of California. •
Date . Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
sub)ecl. 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 It work thereunder is suspended for 180 days.
I certify that I have read this application and state that thetabove information. is: correct.
1 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. 12461
JILDING: TYPE CONST. OCC. GRP.
P. Number 604-232-004
Legal Description Lot 133 Tract 23268 Phase g
Project Description S�` 'Plan D
Sq. Ft- 1835 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $107,763.00
PERMIT
AMOUNT
Plan'Chk. Dep.
Plan Chk. Bal.
560.75
Const.
667.50
Mech.
55.50
Electrical
140.41
Plumbing
138.00
S.M.I.
10.80
Grading
20.00
Driveway Enc.
.00
Infrastructure
2,424.67
Arts in Publlc 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
Side Setback from Property Line
FINAL DATE
Issued by:—
Validated by:
an
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS_
'
COLL. AREA
YARD SPKLR SYSTEM
2ND FL SQ. FT.
ROUGH PLU B.
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
FORMS
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR' P. SQ. FT.
GAS (ROUGH) /�
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT a
OTHER APPJEQUIP.
URINAL
ESTIMATED CONSTRUCTION VALUATION s
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GROUT
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER &T.U.
SQ. FT. ® c
BATH TUB
REMARKS'
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/.c
HOUSE SEWER
FIREPLACE
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 R AIR COND. SOLAR
SETBACK
GROUND PLUMBING JM�/kGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
L
ROUGH PLU B.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR-9ePTPC-TA"r'
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) /�
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL y 43 _
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER,
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus xS
=$
LUMBER GR.
FINAL INSP. y
FRAMING /
FINAL INSP.
ROOFING! � _
(
REMARKS'
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH t
INSULATION/SOUND a/
FINISH, GRADING
FINAL INSPECTIONa
CERT. OCC.
FENCEFINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
IVI
10 .
EB
OF
of ma wuinta
Ara
Ut tnani n,>£
6; issued requiremenis of Section 306
This' ��. of the Uniform B&A
rim, , ''die ued pursuant to the fforrh
Code'dertifying. that at the time of Issuance this structure -was In compliance with the voHilui'
ordinances of the City regulating building construction or use. For the following:
BUILDING ADDRESS 78-775 West Harland
Single Family Dwelling Bldg. Permit No. 12461
i0oup
_Type Construction VX —Fire. Zone use zone SR
Acacia Construction 8141 E. Kaiser Blvd., 4310
Owner. of: 94fidift Address,
Anaheim CA 92808
City °yByl Mark Harold
Mardi ,25 1594'
-Building Official
'PM IN �i 0011NMUOUS PLAN
I
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