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11225 (SFD)4 4 Qum& P.O. BOX 1504 Building 53-791 Obregon 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 owner Synercon Development Corp. Mailing Address 74940 Hwy 112 City Zip Tel. Indian .Melia 92210 564-6929 Contractor Same Address ty State Lic. 337400& Classif. ""y2279 Lic. # "'yr''David Detrick Designer Address Tel. same as above L;Ity IZip I State Lic. # 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. • I ` l,l� ' ,K , I- f giGNATURE 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 file a signed statement that he is licensed pursuant to the provisions of the Contractor's license Law, Chapter 9 (commencing with Section 7000) of Division 3 or 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 five 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 sale. If, however, the. building or improvement is said within one year of completion, the owner-bulider will have the burden of proving that he did not build orenprove 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.) Policyy No .Company H 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 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, 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 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 car ity 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. 11225 BUILDING: TYPE CONST. OCC: GRP. - P. Number Description_ t Description Lot 5 Block 202 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 JN .Permit Validated by: Validation: Sq. Ft. 1 4 6 Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Permit does not include block wall or pool Estimated Valuation 90,367.80 PERMIT AMOUNT Plan Chk. Dep. 250.00 Plan Chk. Bal. 259.67 Const. 599.00 Mech. 55.50 Electrical 126.01 Plumbing 144.00 S.M.I. 9.10 Grading 20.00 Driveway Enc. 00 Infrastructure 1995.03 TOTAL REMARKS 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 JN .Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. FOR. SO. FT. ® GAR. SO. FT. ® CAR P. SO. Ff. 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 ROUGH PLUMB. BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEOUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM GAS (FINAL) TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM B.T.U. I ITEMP 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 FINAL INSP. a SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL REMARKS: SO.FT.GAR ® 34c HOUSE SEWER 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 I 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 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. a FRAMING Gn / FINAL INSP. `'� g3 (w ROOFING , G 4 G ^J /`n n ��A 1 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. rrFIREWALL �HiNG 2 MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION Ct3 CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL P.O. BOX 1504 APPLICATION ONLY Building fq Address 3; - O 2 Owner Mailing Address 7q-- q e1,o City Zip Contractor -1 7&105 CALLS ESTADO LA QUINTA, CALIFORNIA 92253 W Address t City BUILDING: TYPE -CONST. -OCC. GRP. A.P. Number !'� Legal Description .[_61 - 5-I /1 _OeAJ �- Project Description !'S State Lic. City & Classif. 3 3 7 �0 p f Lic. # ZZ, 7 7 Sq. Ft. No. No. Dw. Arch., Engr., Size Stories Units Designer �� ! New ❑ Add A Alter ❑ Repair ❑ Demolition ❑ Address � ^A � Tel. CityI Zip I State Lic. # 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 Businessland Professions Code,.d'nd my license is in full force and effect. !� // ✓ f d�� SIGNATURE OATS OWNER -BUILDER DECLARATION I hereby affirm that 1 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, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant,:to- the provisions of 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 five hundred dollars ($500). I-: 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 did not build or improve for the purpose of sale.) I 1 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.) i 1 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 Co,7pe satigf I�su,�an a fr,a certified c�,py rereof. (S .c. 38 0, Labor Code.) Policy No.�2l?-any i'i �i h: l/ F1 Copy is filed with the city. ❑ Certified copy is hereby furnished. r CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (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 ;as become subject5to tLi�;Workers' • -mpensat Laws of California. � r Date � .Owner NOTICE -Tp PPLICANT: If, after making this Certificate of :Exemption you should become subject to the Workers' Compensation provisions of the-,LabolCode, 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 I t� BUILDING DIVISION PERMIT AMOUNT Plan Chk. Dep. -+ Plan Chk. Bal. Const. ' Mech. >, Electrical "14 Plumbing S.M.I. Grading Driveway Enc. a frastructu.r r 5181 AM f 1W TV-'` y�275.00 y TOTAL REMARKS 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 A FINAL DATE INSPECTOR i Issued by: Date Permit { Validated by: Validation: '' " CONSTRUCTION ESTIMATE NO, ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. $ 2ND FL. SO..FT, POR. SQ. FT. C' GAR. SO. FT. 0 CARP. SQ. FT. Gil WALL SO. FT. (9 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.0OOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) — GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE 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. SQ. FT, c BATH TUB SQ. FT. © c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 1V. c SEWAGE DISPOSAL SQ.FT.GAR @ 3/ac HOUSE SEWER REMARKS: VENTILATION 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 R 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 SIGNATURES/INITIALS GARDEN WALL FINAL DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated (619) 347-8631 Date 9/10/92 Type of Permit I La Quinta No. 11706 Permit # Owner Name Synercon Development Corporation Log # No. 53791 street Obregon city La Quinta Zip 92253 Study Area 110 APN # Tract # Lot # Square Footage 1546 Type of Development Single Family Residence No. of unite 0 _ Comments At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.58 X 1546 lor$2,442.68 have been paid to D.S.U.S.D. for the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By Stuart W. Phelps Telephone 564.6929 Name on the check By James E. Lively Assistant Superintendent, Business Services ; } .w 4. Fee collected /exempted by Vickie J. Durrett r w Payment Received �. Signature Ch®ck Nod` 129 L . Collector: Attach a copy of county or city plan check application form to district copy for all waivers. Embossed Original- Building Dept./Applicant Copy -Applicant/Receipt Copy.- Accounting COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL Received From: -f' Z r c.yY r, J ✓ U /' �� / /�f l/C. F-=/ Ji . Address: 7 tA A" P-oyz, L C//ZG'Lt _ [, Account No. �6la3o _59-, Lot(s) Service Address S3Vll vl eters) ervice(s) 1 , #for ❑ Backflow(s) ❑ House Lateral(s) ❑ Detector Check (s) ❑ Meter Surcharge anitation Capacity Charge s ❑ W.S.B.F.C.' D Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account,- Name ❑ Inspection Fee - Tract - Fee - ❑ Plan Check Fees Water / Sewer - Tract - ❑ Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit ❑ Other Remarks: ki ❑Copy to: Cash Check Money Order N1 -4010 S61 - e / � / Date: Lw. LIC -22 /Z-.T� C',4.. 9,7Z 4 Tract SG BLdC Z G.A. Code 0 DO �C' +✓ 0 0 Q � TOTAL $ Water Service Cashier_4 CVWD-438 (11189) IMEMKIMN i �O5 �� � of -s i �� ,. �C�l- "��SF,� °sem Ilk CTI� I I I i;' is 1 .4 1 TiN of Ed -oututd, til iPLtt�tlt �tn..S�t�P t t ton This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: BUILDING ADDRESS' .53'-791 Obregon- ill Use Classification Single Family Dwelling Bldg. Permit No. 11225 R3 VN SR I Group Type Construction Fre Zone Use Zone II Owner of Building Synercon� Development Address 74940'Hwy 111 City -Indian Wells, CA Lonnie Day 1A Date; March 25, 1993 Building Official— POST' IN A CONSPICUOUS- - PLACE U