13369 (SFD)•
Building
Address 78-830 West Harland
vw„c, Acacia Construction
/-4
4Qu
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailin
Address 81Pi1 F.. Saisor Blvd. 0310
City T
ip Tel.
Anaheim, CA 92808 1 (714)282-58001
Same
Idress
P I Tel.:
City
&tCla sl fc. . B-"1 293954 1 Lic. # 1612
Arcn., tngr., Design
gA
Ad�r6y5l 1r�rina AV'e. TeJ71.)
CitZ'p St to
anta Ana.Hei its, CA 9.1011
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am Iigensed under, provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Busch sand Q�pfissions Code, and my license is in f tp force and
SIGNATURE 8� k a / 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; after, Improve, demolish, or .repair any structure, prior to its issuance also
requires the applicant for such permit to rite a signed statement. that he Is licensed pursuant to
the provisions of the Contractor's Ucense 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 alleped exemption. Any vlolatkin of Section -7031.5 by any applicant for permit
subjects. the.appltcant to a civil penalty of not more than rive:hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure isnot Intended or offered for sale. (Sec. 7044, Suisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
providedthat such improvements are not intended or offered /or safe. If, However, the building
or Improvement is sod within one year of completion, the owner -budder will have the burden
of proving that hedidnot build or improve for the purpose o/ sale.)
❑ I, as owner of the property,•am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner -o! property who builds or Improves thereon, and who contracts /or
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that .I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy N Company
Jt5opy is filed with the city.. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This .section need not be completed If the permit is for one hundred dollar; ($too) valuation
or less.)
1 certify that in the performance of the work for which this permit Is Issued, I shall.not
employ any parson in any manner so as to become subject'to the Workers' Compensation
Laws of C.Iifornia.
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 permitshall 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 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.
I agree to comply with all city and County ordinances and state lawsrelating 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
21
No. 13369
CT p 1
BUILDING: TYPE CONST. _1:, OCC. GRP.- ��7
A.P. Number 604-231-818
Legal Description Lot 22 Tract 23268 Phase 2
Project Description SFD Plan E
Acacia RomelS-
Sq. Ft. 2358 No.- No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑
Demolition ❑
Estimated Valuation $135,692.00
PERMIT AMOUNT
Plan Chk. Dep.,
Plan Chk. Bal.
-� •
Const.
•
Mech.
55•
Electrical 13
9.
Plumbing
5R • O
S.M.I.
13.50
Grading
zu.Vu
Driveway Enc.
•UO
Infrastructure ,53.07-
rr-2 3.n P Z u Places
89.23
TOTAL
•
REMARKS
t 4L
j-1
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 INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
n
YARD SPKLR SYSTEM
2ND FL. SD. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME'SVC.
BAR SINK
POR. SO. FT.
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
-
GAS (FINAL) TEMP. POLE
WALL SO. 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(AUTO)(DISH)
.APPLIANCE DRYER
ROOFING Z
VENTILATION
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
SO. FT. ® c
WATER. HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11A c
SEWAGE DISPOSAL
SO.FT.GAR®'3/ic
HOUSE SEWER
MESH
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 COND. SOLAR
SETBACK
GROUND PLUMBING NDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER, AR ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) O ETER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL 1
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER*(SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu.;yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. Z
FRAMING
FINAL INSP.
ROOFING Z
VENTILATION
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 2
MESH
INSULATIONISOUND %
FINISH GRADING
FINAL INSPECTION '
CERT. OCC:
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL