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10769 (SFD)Building Address 78--590 Forbes Circle Owner Acacia Mailing P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Address 1021 Hastanchury Rd CityZip Tel. Fullerton I92633 1 Contractor Acacia Construction Address s arae State Lic. City & Classif. g 293954 1 Lic. # 1612 Arcn., tngr., Designer Address Tel. CityI Zip I State ' Lic. # I hereby affirm that I amilicensed under pr visioA of Chapter 9 (commencing 7000) of Dlvisiori 3 of t�h/e 8 siness and Prof ssPon Code, and my license is in effect. G 7'�(� l/n� . �� OWNER -BUILDER DECLARATION / 7 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 requres a permit to construct, after, 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 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 the applicant to a civil penalty of not more than rive 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 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 safe. ff. however, the building or improvement is sold within one year of completion, the owner-buider WE have the burden of proving that he did not build or improve for the purpose or 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 Contractors 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.) Policy No. 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 f1 the permit Is for one hundred dollars ($100) vahrafion or less.) I certify that in the performance of the work for which this permit is issued, I stall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become subject to the Workers' Compensation provisions or 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. 10769 (BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description Lot 43 Tract 23268 Project Description Plan. Rev Phase III Sq. Ft.E� �No.` No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ r Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. % � �� a I Wt Qu Mech. sem' . ! �la _&b__SU Electrical /j} ,� . /„/„ 123._&3 Plumbing `/�/� r L32...50 S.M.I. Grading Driveway Enc. Infrastructure TOTAL '5219. 14. REMARKS A, r � , ZONE: U 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 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE 2ND FL. SQ. FT. BONDING YARD SPKLR SYSTEM STORAGE TANK MOBILEHOME SVC. BAR SINK POR. SO. FT. ® DUCT WORK ROCK STORAGE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. I SQ. FT. ® OTHER APPJEQUIP. DRAINAGE PIPING WALL SQ. FT. TEMP. POLE DRINKING FOUNTAIN. SQ FT ® GROUT URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES _$ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE,TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL LATHING SQ.FT.GAR ® VAc 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 UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. 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. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR, GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESJINITIALS GARDEN WALL FINAL Plan B Rev Phase III A r Gd � 43 y ^~ CITY OF LA WINTA DEPARTMENT OF PLANNING & DEVELOPMENT BUILDING DIVISION 564-2246 24-HOUR NCEINIONNOUIRCTIONS JUL z 1 1992 e Owner Acacia ,tern, Contractor Acacia Const.ru kT"T Permit Number 10769 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOBADDRESS 78-590 Forbes TYPE OF INSPECTION EIATE INSR FOUNDATION & SETBACK FOOTING STEEL MAIN GROUND SYSTEM GROUND PLUMBING L Z PRE-GUNITE uU NU I PUUH CONCRETE UNTIL ALL ABOVE HAS BEEN SJr;NED CONCRETE SLAB JOISTS & GIRDERS ELECTRICAL GROUND WORK DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS & GAS TEST ? p L HEATING & VENT -A/C FIREPLA,CE ROOF / BOND MAM O.K. TO WRAP GROUT ❑ 4' ❑ 8' FRAMING INSULATION PRE -ROOF COVER NO WORK UNTIL ABOVE H S B EN SIGNED DRYWALL INTERIOR EXTERIOR LATH rL POOL PRE PLASTER POOL FENCE & GATE SEWER SEPTIC TANK .r. FINALS ELECTRICAL f r f PLUMBING ` FINAL GAS TEST HEATING -A/C HOUSE NUMBERS JOB COMPLETED TEMP POWER ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING A/AA