12463 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 78-795 West Harland LA QUINTA, CALIFORNIA 92253
Acacia Construction
Mailing
.Address 8141 R. Kaiser Blvd. 0310
City Zip Tel.
Anaheim, CA 92808 1714)282-5800
Contractor
Acacia Con ,traction •
Tel..
State uc• B-1 293954I`'Ity 1612
& Classif. Lic. #
Desi
gner
., crryr.r DC Design
Desi
AIM Irvine Ave. TA4) 641-1505
GSanta AnReid its, CA 92 �I tate
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l 8m 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 DATE -
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
Permit to construct, alter, improve, demolish, or repair any structure.. prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the .provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Dlvision,3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for -the ,alleged, exemption. Any violation of Section 7034.5 by 'any applicant for a permit
aubjectsthe,,applicant to a civil penally of not more than five hundred dollars ($500).
p; ",as`,owner,of the property, ormy 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. hwroves . thereon and who does such work himself or through his own employees,
provided that such 'Improvements are not intended or offered for sale. ff, 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.)
❑ I am,exempt under.Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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
❑,Copy is filed with the city. ❑ Certified copy is hereby furnished.
t
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section -need not De completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which thls'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: ff, 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 If 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 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. 12463
11LDING: TYPE CONST. OCC. GRP.:
P. Number 604-232-006
Description Lot -.135 Tract 23368 Prase l'
t Description SFD 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 DATE I#J9PE5TAfi ---,
Issued by: Date
Validated
Validat
1 IVU V
r�
Ry %�;
Sq. Ft. 1591 No.
Size Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation $94,64-9.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
521.02
Const.
612.50..
Mech.
55.50
Electrical _ . '
131.49
Plumbing
144.00
s.M.l.
9.50
Grading -
20.00
Driveway Enc.
04
Infrastructure
2,129.59
TOTAL
.3 623.60
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 I#J9PE5TAfi ---,
Issued by: Date
Validated
Validat
1 IVU V
r�
Ry %�;
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. F7. ® $
UNITS
COLL. AREA
°
3
YARD SPKLR SYSTEM
2ND FL. S0. 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. I SO. FT.
GAS (FINAL)
WALL SO. FT.
DRINKING FOUNTAIN
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used a8 property tax valuation
FLOOR DRAIN
MECHANICALFEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
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.
SO. FT. ® c
BATH TUB
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LATHING
MESH
SO.FT.GAR Vkc
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 Z 3
GROUND PLUMBING , Z
ERGROUND
A.C.-UNIT
COLL. AREA
SLAB GRADE 2 6
3
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. Z
GAS (ROUGH / a %Y/,k
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. 3 / f
FRAMING /
FINAL INSP.
ROOFING /( /�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION 2 ��
CERT. OCC.
FENCE FINAL
INSPECTOR'SSIONATURESIINITIALS
GARDEN WALL FINAL
(jai
.1'. 1%
Cott Of 41 a (OUM a
�4.,
This "Certificate Issued pursuant to the requirements of' Section 306 of the 'Uniformi Bulldl
Code certifying that at the time of issuance'"fhls structure was Incompliance with the var,166i
ordindince'"s"ol the City regulating Wilding construction, or use. For the following::
BUILDING ADDRESS 78-795 West Harland'
Single Family Dwelling 12463
itelfw on__ side. ftrrnit No.
"JO Type Construction VN —fire Zone Use Zone SR
ftner of n Acacia Construction Address 81411 E. Kaiser Blvd. 1#316
City.Aniaheim, ,qA 92808
Mark Harold
:07 Byl
March 25, 1994
Building Offic of
-ilt At 1"6661M PLAM
tit