13995 (SFD)T"tt - u
P.O. BOX 1504
riding 78--860 West Harland Dr LA QUINTA8-105 C
dALLE ES I ADO
rPsc CALIFORNIA 92253
Uwn%cac i as construction I
Adar'ess 6141 S. Kaiser Blvd. 0 310
City Zip Tel.
Anaheim 92808 (714) 282-5800
Contractor
Sammi
State Lic. City
R Classif. H-•1 293954 Lic. # 1612
Arch:, Engr-
Designer DC Design
Addr %351 Irvine Ave. IVIG 641-1505
CityZip State
Santa:',1Uxa H ghts 9270 lic.#
LICENSED CONTRACTOR'S DECLARATION
J�1 hereby Ni,3
t I am licensed under provisions of Chapter 9 (commencing with Section
'�+i000) of Dof the Business and,Professions Code, and my license isdn full force and-
effect.
SIGNATUREDATE
OWNER -B LDER DECLARATION
I hereby affirm. that I am exempt from the Contractor's, License Law for the following
reason: (Sec. 7031.5,Busfness 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 .pie a signed statement that he Is licensed pursuant to
the provisions or the Contractor's License 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 alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects applicant. to a civil penalty of not more than live 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 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 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.)
❑ 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.)
❑ 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.)
12014y4 Company
❑'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 the work for which this permit is Issued, I shall not
=any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
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 provislonaor 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. 13995
BUILDING- TYPE CONST. " OCC: GRP. R3
A.P. Number 604€-231-013
Legal Description Lot. 19 Tract 23268 Phase 3
Project Description SFD Plan F
Acacia
Sq. Ft. 23r�8 No. No. Dw.
Size Stories Units
New O' Add E Alter O Repair ❑ Demolition ❑
stimated Valuation $14-1,073.00
PERMIT
AMOUNT.
Plan Chk. Dep.
Plan Chk. Bal.
658.86
Const.
786.50
Mech.
55.50
Electrical
159.33.
Plumbing
168.00
S.M.I.
a
Grading
20.00
Driveway Enc.
—0—
Infrastructure
3 17 4 . 5
Arts in P>ia TIM Places
102.158
TOTAL
REMARKS
ZONE: BY: r
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. in
Side Street Setback from Ce in
Side Setback firom Propert
FINAL DATE
Issued by: Dat
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. a S,
UNITS
A.C. UNIT
`
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT.
ROUGH PLUMB. 1
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
SEWER
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. SO. FT. ®
METER LOOP
HEATING (FINAL)
WALL SO. FT.
REINF. STEEL
DRINKING FOUNTAIN.
GAS (FINAL) 9
URINAL
SO. FT. ®
GROUT
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOKDISH)
APPLIANCE DRYER
LUMBER GR.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FRAMING/ Z
LAUNDRY TRAY
AIR HANDLING UNIT CFM
ROOFING
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 ® 1.% c
SEWAGE DISPOSAL
SO.FT.GAR ® 34c
HOUSE SEWER
GAR. FIREWALL
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 GOND. SOLAR
SETBACK
fl
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. 1
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) /
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) 9
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. `
FRAMING/ Z
FINAL INSP.
ROOFING
�p
I/
/
/(G
REMARKS:
VENTILATION
FIRE ZONE ROOFING -
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATRING
MESH
INSULATIONISOUND /
FINISH GRADING
FINAL INSPECTION I'Nfl--)
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL