12458 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 78-780 West Harland LA QUINTA, CALIFORNIA 92253
Owner Acacia Construction
mailing
Address 8141 R. Kaiser Blvd. 0310
City Zip Tel.
Anaheim, CA 1 92808 1010282-5800
Contractor
Acacia Construction
p
Me Classif. B--1 293954. L"yJi 1612
�rryr.' n DC Design
g'
Ad295%1 irvine Ave. 11114) 641-1505
Santa Ana fteiohts, CA 9115.7
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed'under provisions of Cha
ptaner 9 (commencing with Section
7000) of Division'3 of the Business,and Professions Code; d my license is in full force and
SIGNATURE t' r.' DATE
OWNER -BUILDER DECLARATION
I 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, after, 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 ihaQontractor'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, or my employees with wages as their sole compensation, will
do theiwork, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professkins Code: The Contractor's License Law does not apply to an owner of property who
builds":ei 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
orJmprovement is sold within one year of completion, the owner -builder will have the burden
of proving tliat he did not build or Improve for the purpose of sale.)
O 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�Contrector's License Law.)
0 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, ora certified copy thereof..(Sec. 3800, Labor Code.)
PolIcy. No. -'l Company
❑ Copy, is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed If the permit is for one hundred dollars (5700) valuation
or less.)
I certify. that in the performance of th¢ 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, 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 permit shell be deemed revoked.
CONSTRUCTION LENDING AGENCY
1hereby 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 abuilding 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.
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. 12455
JILDING: TYPE CONST. OCC. GRP.
P. Number 604-231-005
Description Lot 27 Tract, 23268 Phase 1
t Description
SFD Plan D
Sq. Ft. 1835 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
stimated Valuation *1071l,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
Arta 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
Side Setback from Prooerty Line
FINAL I
Issued t
Validate
Validati
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
'
ROUGH PLUMB. BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWA ROUGH WIRING,
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH) 9117 lJ METER LOOP
o
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL) TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT.
GROUT
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN,
SO FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
ROOFING
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77
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
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
MESH
SO: FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT..RESID ® 1% c
SEWAGE DISPOSAL
FINISH GRADING
SO.FT.GAR ® 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL. HEATING & AIR GOND. SOLAR
SETBACK
'=� I r'
GROUND PLUMBING 1 (' ( h1mERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
i
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWA ROUGH WIRING,
DUCT WORK
ROCK STORAGE
FOUND. REINF.(
GAS (ROUGH) 9117 lJ METER LOOP
o
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL.
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. ,3 'y r �
L FINAL INSP.
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING r /3
ROOFING
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77
%
/ 'y AA,
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND�l--
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'SSIGNATURESlINITIALS
GARDEN WALL FINAL