10856 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 53-065 Oegozf LA QUINTA, CALIFORNIA 92253
Owner
Synercon Development Corp
Address 7494.4 Hwy ill #5429
City—TT—elZip :
I.W. 92220 7T1-3303
Contractor
SYnercon bev. JTony Plescl,a
.Address..
same
Zip I Tel.:
State Lic. I City
& Classif. 337400 Lic. #
Arch:, Engr.,
Designer
Address Tel.
No. .10856
LDING: TYPE CONST. OCC: GRP.
P. Number
.egal Description
Project Description
SFD
Sq. Ft. No. No. Dw.
Size Stories Units '
New ❑ Add.0 Alter ❑ Repair ❑ -Demolition ❑
NOTE: SUPPLEMENTAL PERRIT ONLY t 1 A CHAN(
City
Zip
State
Lic. #
OF CONTRACTOR. MRS
PAID ON
PEtFYT "10430
LICENSED CONTRACTOR'S DECLARATION
I hereby. affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of; Division 3 of the -Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
77 OWNER -BUILDER DECLARATION
1 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, atter, 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 of the Contractor's License Law, Chapter 9 (commencing. with Section 7000) or
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. applicantfor a permit
subjects the applicant to'a civil penalty of riot more than Ove 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, Busness 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
orimprovement Is sold within one year of completion, the owner -builder will have the burden
of proving,that he did not build or improve for the purpose of sale.) -
O 1, as owner of the property, am exclusively contracting with licensedcontractors to cor►.
Strutt 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.)
11I am exempt under Sec. B. & P.C. for. this reason
Estimated Valuation
-
PERMIT -
'
'AMOUNT
. Plan Chk. Dep. -
Plan Chk- Pal.
Const.'
Milch,
- '
EleCtrlCal
Plumbing
..
S.M.1.
Grading
Driveway Enc.
Date owner
Infrastructure
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.)
•
Policoom .Company
"Copy is filed with the city. O Certified copy is herebytumished.
TOTAL Xks J?LX
n/a
CERTIFICATE OF EXEMPTION FROM REMARKS
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 thg 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: n, after making. this Certificate of Exemption you should become
subject to -the Workers' -Compensation provisions of the Laboi 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 abuilding permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certity that 1 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
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:
1 ..
Validation:
I
CONSTRUCTION ESTIMATE
NO. ,Im ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SO. FT.
WALL SO. FT.
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
' MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SO.FT.GAR @ Mc
HOUSE SEWER
REMARKS:
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
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 APPJEOUIP.
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
i
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL