12469 (SFD)4
;Q9 78-785 West Harland
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Acacia Construction �
Address 0141 E. Kaiser Blvd. 1310
City Zip el.
hnaheim, CA. 92808 .171411282-5800
Contractor
Acacia Construction
Address
State Lic.
& Classif. H_1 293,954 CityLic. it 1512
Arch., Engr" D4✓83
Designer Vt
2 Irvine Acre. 101'4116 41--1505
City lZip State
S=anta, tai;a .Het Its, Cfi, 94 ViBlft
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am 'licensed under Provisions ofChapter 9 (commencing with Section
7000) of Division 3 of the Business.and'Professlons Code, and my'license is in.full force and
effect.
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,Buslness and Professions Code: Any city or county which requires a
Permit to constrict, after, Improve, demolish,or repair any structure, prior to its Issuance also
;;quires the,AT"cant-/or such permit to Me a signed statement. that. he Is licensed pursuant to
the provisions o/ the Contractor's license Law. Chapter 9 (commencing with Section .7000) of
Division 3 of the Business and Professions Code, or .thathe, is exempt therefrom, and the basis
/or the alleged exemption. Any violation o/ Section 7031.5 by any applicant for a permit
subjecWthe applicant to a civil penalty of notmore than live hundred dollars (5500): _
O 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. If, 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.)
ti I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct- the projecti (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.)
Policy:No. Company
O,opy Is filed with the city. O Certified copy is.hereby furnished.
f
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 Califo_ rnia.
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 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.
1 agree to comply with.all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-
mentioned property for Inspection purposes.
Signature of applicant -Date-
Mailing,
ateMailing: Address
City, State, Zip
No. 12469
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 604--232-005
Legal Description Lot 134 Tract 23268 Ph«se 1
Project Description SPD Flan Fa
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
Issued
Validat,
Validat
Sq. Ft. No.
.Size _ 2358 Stories
No. Dw.
Units
New ❑ Add O Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $135,692.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
643.05
Const.
7.6 5.50
Mech.
55.50
Electrical
15 4 . 3 3
Plumbing
160 , 00
S.M.I.
13.60
Grading
20.00
Driveway Enc.
Q0
Infrastructure
3,053.07
Arts in Publi Places
89.23
TOTAL
4,967.28
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
Issued
Validat,
Validat
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
DOLL. AREA
SLAB GRADE
3
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
__METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. 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(AUTORDISH)
APPLIANCE DRYER
ROOFING
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.
SQ. FT. ® c
BATH TUB'
SPARK ARRESTOR
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
e--G-HIN/v
MESH
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
GROUND PLUMBINGl
ROUND
A.C. UNIT
DOLL. AREA
SLAB GRADE
3
feWUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEW
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) /, pe
7T
__METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL Y
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 Y ! fl
FRAMING /
FINAL INSP.
ROOFING
11�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR.; FIREWALL
e--G-HIN/v
MESH
INSULATIONISOUND
mz�dlf-
FINISH GRADING
FINAL 'INSPECTION 3
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL
(41e
P-
�C��t of 14a QUtlitM
llulbin�, aub - *afet� '443finelioll
This Certificate issued pursuant to the requirements of Section 306 of the Uniform, Building!
Code certifying that at the time of issuance this structure was In compliance with the various
ordinances, of the City regulating building construction or use. For the following::
BUILDING ADDRESS 78-7,85 West Harland
Use Clatelficotion Single Family Dwelling Bldg. Permit No. 12469
Group R3 Type Construction VN Fire Zone Use zone SR
Owner of Building
Acacia,ConstAddress
ruction 8141 E. Kaiser BlVd. #310
City Anaheim, CA 92808 Byl. Mark Harold
Date, March 25, 1994,
Building Officiol Posy IN A CONSVICUOUS PLACE.