13993 (SFD)t
P.O. BOX 1504 No. 13993
Building 78-040 ^lest Harland Dr LA QUINOTA, CALIFORNIA 92253
Address
Owner Acacia Construction
BUILDING: TYPE CONST. • OCC: GRP. R3
Mailin
Address 8141 Eo Kaiser Bled. 0 310A.P. Number
604-231-011
Cityr92808
ip Tel.
Anahaim ; 1(714)282-5800 Legal Description Lot 2.1 Tract 23268 Phase: 3 -
Contractor Project Description 1, SPD' Plan C -
Same Acacia Holes
Address
City Zip Tela
State Lic. City
& Classif. B-1 293954 Lic. # 1612 Sq. Ft- 1591 No. No. Dw.
-Arch.; EngSize Stories Units
• r.; - - - - - .
Designer DC Design New ❑ Add ❑ Alter [I Repair ❑ Demolition ❑"
Address - Tel.
20351 Irvine Ave. (714) 5411505 -
City - Zip State
Santa Ana S ghts 9270 Lic. #
r LICENSED CONTRACTOR'S DECLARATION
i hereby affirm tha_t.l'am licensed under provisions of Chapter 9 (commencing with Section
s �p00) of Divisi f the Business'and fessions Code, and my licens Js Il
in torce and
(effect:Vo
..0
SIGNATURE DATE
OWNER-BUIL ER DECLARATION Estimated Valuation
I hereby affirm hat I am exempt from the Contractor's License Law for the following $98r445.00
a
reason: (Sec. 7031.5,ousiness 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
rn°B p".Is n o t c�racM s tense Law,le a �Chapterm8 (commencing tement I I he Is licensed wph Sectlonu 000j of PERMIT AMOUNT
Division 3 of the Business and Professions Code, or that" he is exempt therefrom, and the basis
for the at tey exemption. , five Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects therapplkant to a cm/ penalty of not more than e hundred dollars (a500). Plan Chk. Bal. - _ -536.78
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will — '635.00
G
do the work, and the structure is not intended or offered for sale.'(Sec. 7044,,Buisness and Const. 3rD . QQ
Professions Code: The Contractor's License Lew does not apply to an owner of property who - -
builds or Improves thereon and who floes such work himself or through his own employees, Mech. 55.50
provided that such Improvements are not intended or offered for sets. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 131.49:
of prov/ng that he dM not build or improve for the purpose of sale.)
D I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 144'.00-
struct the project. (Sec. '7044, Business and Professions Code: The Contractor's License Law 9.84
� G w
does not apply to an owner of property who builds or improves thereon, and who contracts for .S.M.I. 9 . 8 4 .
'-such projects with a contractor(s)1kensed pursuant to the Contractor's License Law.) - -
❑ 1 am exempt under Sec d, g P.C. for this reason Grading 20.00
Driveway Enc. —0 ----
Date owner Infrastructure 2215A7
02
WORKERS' COMPENSATION DECLARATION 3 7 4 7.6 3
I hereby flrm that I have a certificate of consent to self -insure, or a certificate of
Worker's C ensation.lnsurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Polic Company
❑ opy is filed,with the city, ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be, completed It the permit is, for one hundred dollars ($100) valuation
or lass.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any mannerso as to become subject to the Workers' Compensation
4. Laws of California
Date - Owner
NOTICE TO APPLICANT: n, alter making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shah be deemed revoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
��- - Side Street Se k Center Line
1 hereby at
that there is a construction lending agency for the performance of the
work for which this permit is issued_ (Sec. 3097; Civil Code:) Side Setback PrMECTO Lender's Name
Lender's Address FINAL DATE IN P
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. Ni.
1 certify that 1 have read this application and state that the above information is correct. Issued by: ate Perrtilt
I agree to comply with all city and county ordinances and state laws relating to building �1i //ft���
construction, and hereby authorize representatives .of this city to enter the above - J �j
menttoned 'property
for inspection purposes. Validated by:
111111
Slgnature.of applicant Date j
Mailing Address Validation: 1
City, State, Zip ++
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ: FT. ® $
UNITS
A.C: UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT.
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
SEWER
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. SO. FT. ®
METER LOOP
HEATING (FINAL)
WALL SQ, FT.
REINF. STEEL
DRINKING FOUNTAIN.
SQ FT ®
GAS (FINAL) I
URINAL
ESTIMATED CONSTRUCTION VALUATION E
, WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES.
FINAL INSP.
WATER SOFTENER,
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
KITCHEN SINK
ABSORPTION SYSTEM B,TM.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE; TEWPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
FIRE ZONE ROOFING:
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 1 V. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Ac
HOUSE SEWER
GAS' PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
—L
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 PLUMBING
UNDERGROUND
A.C: UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.JEQUIP.
REINF. STEEL
GAS (FINAL) I
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
y —plus—x$
=S
LUMBER GR.
�f
FINAL INSP. 2 (
FRAMING
FINAL INSP.
ROOFING
f7
r
:•
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LAT riiNG
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
08/21/03
16:09
qUg 1`9 03 12:10p
CDFAR.IFACOSTAMESA 4 7607777011 N0.311 902
Blue Haven Pools
Cooperative ted Imported Dire Ant Project
Noti%estion of Intent to Move Soil from or within Quarantined
A f Oran a Riverside and Los Angeles Counties
reRS Q f . 1 ._
Permit p
fUyA Compliance Agreennent # Itsuing City/Couery
Agency
Name o! Company Regt►estirg Approval: V
Contact Person: 1
,�%' City: �)Zip:
Addtess! - 11
Pax:
Excavation Location; �• � %,�'� � �� '�'f,`� ��.��l;;�l `'� ��� , TB`:�,�,._.,,..
ACRES:._._--
. �..,
Destination Location:wo
ACHES'.- _
Estimated Quonlity of Soil (e:g. ;$ Cubic Yards):_
Anticipated Date of Moverment:
Urgency Level fat lo+anediate Inspection and Release! {Circle Ones "jib
.[a Movement of Sotl is Permitted.
0 Hold. Movement Until Site Checked • WE WILL CALL AS SOON AS POSST$LE10
SCIIEDtILE TNSPECTION DATE AND TIME, Tra epi by: Acres:_.
pate Trapped: a of Traps: pp ...a:
Pon
Date Picked UpCotnmertrs::���
Soil Movement is Strictly Prohibited for ibe Following Reason(s):
Name of R1FA Project Regula
�~
Signature:. "
0.e•:4l l �4v �
• To 0 Tltiomaw page and gr+d Octibnptioa
(-
Datta: