12457 (SFD)ilding
Owner
4 4 Qt4
P.O. BOX 1504
78-105 CALLE ESTADO
78-790 Weet Harland LA QUINTA, CALIFORNIA 92253
Acacia Construction.
Address 8141 B. Raiser Blvd. 0310
City Zip Tel.
Anaheim, CA 1 92808 1(714)282-5800
Acacia Construction
idress
Zip
State Lic.p_1 293959 (City 1612
& Classif. Lic. #
Arch., Engr., DC ign
Designer
1 Irvine Ave. 1(714) 641--1505
clZip
it9anta Ana Heights, CA 91vin
LICENSED CONTRACTOR'S DECLARATION
I hereby -affirm that I am. licensed under provisions of Chapter 9 (commencing. with Section
7000) of Division 3 of the Business and Professions Code, and my license is In full force and
effect: ]r
SIGNATURE r. DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the. Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any city orcountywhich requires a
,permit to construct, alter, Improve, demolish, or repair any structure, prior to its Issuance also
regidres=the applicant ;for such permit to Nle a signed statement that he Is licensed pursuant to
the proviskms of the Contractor's License' Law, Chapter 9 (commencing with Section 7000) of
Ddvislon 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
subjectsthe 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 the work; and the structure is not Intended or offered for sale. (Sec. 7044, Bulsness and
Pro/esalons Code: The Contractor's License Law does notapply 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.)
❑ 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 projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O. -I -sib exempt under Sec. B. & P.C. for this reason
Data Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Com
s pensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No`Cpmpany
O 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 thg work for which this permit is issued, I shall not
employ any pperson 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 or 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 valldated, and is subject to
expiration if work thereunder is suspended for 180 days.
1 certify that I have read this application and state that the above iinformation is correct.
I agree to comply wlth.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
2
No. 12457
BUILDING- TYPE CONST: OCC: GRP.
I
A.P. Number 60�"P21�Ofl6
Legal Description Lot 26 Tract 23268 Phase.
Project Description 5F13 Ian $
Sze 12358 Stla
New ❑ Add ❑ 1
(Estimated Valuation $135,692.00
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
No. Dw.
Units
Repair ❑ 'Demolition ❑
AMOUNT
64
Plumbing
168.00
S.M.I.
13.60
Grading
20.00
Driveway Enc. I
.00
Infrastructure
3,053.07
Lrts in Publi laep-m
313.2
TOTAL
REMARKS
ZONE:
B'
Minimum Setback Distanc
Front
Rear;
Side!
Side
FINAL DATE
Issued by:
Validated by:
Validation:
back from Center Line
lack from Rear Prop. Line
Bt Setback from Center Line
ack from Property Line
Jr NOV ? 4- 1993.
r .
i �,
CONSTRUCTION ESTIMATE.
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. 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 SO. FT.
DRINKINGFOUNTAIN
SO. FT. @
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
,yd.
plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
P
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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B,T.U.
SQ. FT. c
BATH TUB
SQ: FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR-® 3/ic
HOUSE SEWER
MESH
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 Y
Z�
GROUND PLUMBING r A�.ABEAGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWEREPfif63id/llta ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. y
-17
GAS (ROUGH) �T! 4/ METER LOOP
`
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. 4&-t---cu.
FINAL INSP.
GRADING
,yd.
plus x$
=$
LUMBER GR.
FRAMING l / 3
ROOFING
/ �� /
P
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL