12465 (SFD)P.O. BOX 1504 No. 12465
Building78-105 CALLE ESTADO
Address 78--815 We5 t Tiarland LA QUINTA, CALIFORNIA 92253
Owner, Ac -ruction
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address 8191 Ee wises Blvd. 0310 609-232-008
A.P. Number
City Zip Tel.
Anaheim, CA . 92808 7191282--5800
Construction
State LIC. B-1 293959 (city 1612
& Classif. Lic. #
Designer
Arch.,
C Design
AltUr1. Irvine Ave. TW 691-1505
'Santa Ana Hei jg6 il, CA 92 #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am license6 u4irprovisions of.Chapter 9 (commencing with Section
7000) of Division 3 of the Bust n 8410 Professions Code, and my license is in full force and
effect. �
)_ rj�
SIGNATURE � "' '../' DATE
OWNER -BUILDER DECLARATION
I heieby affirm that I am exempt from the Contractor's License Law for the following
reason:, (Sec.-7Q31.5,Buslness 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 file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3,6f the:Buslness 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 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 or 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 dM 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'contrects for
such projects 1 with a contractor(s) licensed pursuant to the Contractor's Llcense'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, ora certified copy thereof. (Sec. 3900, Labor Code.)
Policy No: Company
❑ Copy is filed with the city. d 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 dollar; ($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 California.
Date Owner
NOTICE TO APPLICANT. It, 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
(Legal Description Lot 137 Tract 23268 Phase i
Project Description Plan E
Sq. Ft. No. No. Dw.
Size 2358 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $135#,692.00
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. 643.05
Const. 765.50
Mech. 55.50
Electrical 159.33
Plumbing 168.00
S.M.I. 13.60
Grading. 20.00
Driveway Enc. .00
Infrastructure 3,053.07
Arts in Public: Places 99.23
TOTAL4 s 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 DATE,
Issued by:_
Validated by:
Validation:
TOTAL4 s 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 DATE,
Issued by:_
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
ROUGH PLUMB
43 0a
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
FORMS
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR P. SQ. FT. ®
GAS (ROUGH)/�/F
WALL SO. FT..®
DRINKING FOUNTAIN.
HEATING (FINAL)
OTHER APPJEQUIP.
URINAL
SQ FT. ®
GAS (FINAL)
TEMP. POLE
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GROUT
FLOOR DRAIN
MECHANICAL.FEES
SERVICE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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
SQ. FT. a c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Vi c
SEWAGE DISPOSAL
SO.FT.GAR @ 3Ac
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 I )— Z ? 3
Au
GROUND PLUMBING Z3
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE3
ROUGH PLUMB
43 0a
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. Q3
/
GAS (ROUGH)/�/F
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
g
GRADING
cu. yd.
plus xi
=$
LUMBER. GR.
FINAL INSP. %�
FRAMING l
FINAL INSP.
ROOFING iLI110
%�'✓_J/v�
f�l
/ �� ;I f O'
1L/Z-
REMARKS:
VENTILATION�f
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
/
LATHING t�✓/�/
MESH
INSULATION/SOUND a
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS"
GARDEN WALL FINAL
111
j
C tit of01 "a' U i n t a : z.
uta to aub��Ptttu�t r+
This, -Cte issued pursuant to the requirements of Section 306 of the Uniform Bulldihol,.,
Codecert !Y!0" that at the time of issuance. -this structure was In compliance with the va
9 ri
ordinances of the City regulating building construction or use. For the following:
BUILDING ADDRESS 78-815 West Harland
Use Clos~on Single,Family Dwelling Bldg. Permit No; 12465
Group Type Construction VN Fire Zone use Zone
Acacia Construction 8141 E. Kaiser Blvd, 010
;Owner of Buildidq Address
Anaheim, CA 92908
City Mark Harold
By:
March 25, 19
94
Dote;
k,
Wing Officlol
low IN A J001119"49OVII PLA46