11991 (SFD)Building
Address
Owner
51-665 Carranza
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Synercon Development Corp.
Mailing
Address 74-940 HWy 111
City Zip Tel.
Indian Wells, % 92230 1 564-6929
Contractor
Same
p
State Lic. 65528(City 24:19
& Classif. Lic. #
De„y, ., I
signer
Address I 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 Business and Professions Code, and my license is in full force and
I � i
_SIGNATURE 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, 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, 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
or proving that he did not build or improve for the purpose of sale.)
0 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.)
0 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 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 i1 the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of lhp 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
Ihereby 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.
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 773~124-020
Legal Description ?sot 8 Block 56
Project Description SFD
Sq. Ft
Size
New [
1375 Stories
11991
No. Dw.
Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
Permit does not include block i
IEstimated Valuation $81,425.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
480.84
Const.
558.50
Mech.
62.00
Electrical
120.03
Plumbing
144.00
S.M.I.
8.20
Grading
20.00
Driveway Enc.
—0—
Infrastructure
1,793.80
TOTAL
3,187.37
REMARKS
_iiV_''tic -
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
Issued by:_
Validated by:
Validation:
INSPECTOR
Permit
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FE
1ST FL. SO. FT. ® $
UNITS
I
ROUGH PLUMB. BONDING
HEATING (ROUGH)
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
SEWER -9 SEPTIC TANK-7_JOUGH WIRING
DUCT WORK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
HEATING (FINAL)
OTHER APPJEOUIP.
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GROUT
DRAINAGE PIPING
CAR P. SQ. FT.
BOND BEAM
WALL SQ. FT.
GRADING
cu. yd.
$ plus x$
DRINKING FOUNTAIN
LUMBER GR.
FINAL INSP.
c [
URINAL
SO. FT. ®
ROOFING (,��2 �
VENTILATION
^�/%// /G, � L�
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FIRE ZONE ROOFING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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.
SQ. FT. RESID ® 1114 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FENCE FINAL
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 l UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER -9 SEPTIC TANK-7_JOUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE Gl'3
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
c [
FRAMING 2
FINAL INSP.41 qr(�
ROOFING (,��2 �
VENTILATION
^�/%// /G, � L�
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LA I -1 3 cp
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION (�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
F 14 is
"ZtPanj�M
kk %
Chi of 14.0 Qututu
This Certificate issued pursuant. to the requirements of Section 306 of the Uniform Building!
Code certifying that of 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' 51-665 Avenida Carranza
Use Classification Single Family Dwelling Bldg. Permit No. 11991
Group R3 Type Construction VN Fire Zone Use Zone SR
Owner of Building Synercon Development Address 74-940 Hwy 111'
City Indian Wells, CA 92210 Lonnie Day
ey , -
,4� Dote. January 27, 1994
Building Official
POST IN.A CONSPICUOUS PLACE
u�l'jt,�Gv
P.O. BOX 1504 N 0 . 119 91
Building 78-105 CALLE ESTADO
Address 51-665 Carranza LAQUINTA,CALIFORNIA 92253
Owner
Synercon Development Corp. BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address 74-940 wV 111 A.P. Number 773-124-020
Cityzip Tel. Lot 8 Block 56
Indian Wells A 92210 564-6929 Legal Description
Contractor Project Description SFD
Same
Address
ty
State Lic. I City
& Classif. 65528 Lic. # 2 419
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 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
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 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 applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). '
O 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 irproves 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.)
O 1, 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 1 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'COMPENSATIONINSURANCE
(This section need not be completed i1 the permit is for one hundred dgllars ($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: 8, 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
Lenders 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.
1 certify that 1 have read this application and state that the above information is correct.
1 agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Sq. Ft.
Size 1375
No. No. Dw.
Stories Units
New Add ❑
Alter ❑ Repair ❑ Demolition ❑
Permit does
not incl1iAP hlnek wA11s or
pool.
Estimated Valuation
$81,425.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
480.84
Const.
558.50
Mech.
62-00
Electrical
Plumbing144
QQ
S.M.I.
Grading
Driveway Enc.
Infrastructure
1 ,793.80
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 Permit
Validated by:
Validation:
t
"Y
Installation Certificate: Residential CF -613
Use of this form to satisfy the requirements of the Administrative Code Is optional, but the Information must be provided and posted.
Site Address Permit Number
An installation certificate is required to be posted at the building site prior to the issuance of the occupancy permit. This form
may be used to meet these requirements. All appliance categories listed below are the actual equipment installed. Note that
the eff iciency and type of the appliance installed must be equivalent or better than the appliance specified on the Certificate of
Compliance (CF -1R). This certificate (or its equivalent) shall be prepared and signed by the person(s) assuming overall
responsibility for the appliance installation.
I, the undersigned, verify that the equipment listed in the category above my signature is the actual equipment installed and
that the equipment meets or exceeds the requirements of the Appliance Efficiency Standards. In addition, I have verified that
the equipment is equivalent to or more efficient than the equipment specified on the Certificate of Compliance submitted to
demonstrate compliance with the Energy Efficiency Standards for residential buildings.
HVAC SYSTEMS
Note: Hydronic boiler information is entered here. Other hydronic or combined hydronic equipment is listed under
Water Heating Systems.
Heating Equip. CEC Cert Hied
Type (furnace, Manuf. Make &
heat pump, etc.) Model Number
UA�W;LVLVAWR" .
Actual Distribution Duct or Heating Load Heating
EHlclency Type and Plping Before Over. Equipment
(AFUE, etc.) Location R -Value Sizing (Btu h) Capacity (E
99 Joao
it F Pimp
CEC Certffled
Cooling Equip. Compressor Unit Actual Distribution Duct or
Type (air cond., Manuf. Make & EHlclency Type and Plping
heat pump, etc.) Model Number 1SEER)29-2 Location R-l/alus
E Rr�N®4 ISS sat ATT 1 e
The building design heat loss and design heat gain rate have been determined using a method specified in Section 150(h) of
the Energy Efficiyncy Standards, and are two of the criteria used for equipment sizing and selection.
Signature
7 ate HVAC Subontractor (Co. Name) or General Contractor or Owner
WATER HEATING SYSTEMS
Energy'
External
Water Heating CEC Certified
Rated' Tank • Factor or
Tank
System Type Manuf. Make &
Input (kW Capacity Recovery Standby
Insulation
(storage gas, etc. Model Number
or Btuh(gallons) Eff Iclency Loss %
R- alue
D
1. For small gas storage (rated inputs 75,000 Btu/hr), electric resistance and heat pump water heaters, list Energy Factor.
For large gas storage water healers (rated input >75.000 Btu/hr). list Rated Input, Recovery Efficiency and Standby Loss.
For Instantaneous gas water heaters, list Rated Input and Recovery Efficiency.
For Instantaneous electric water heaters, list Rated Input.
FAUCETS & SHOWER HEADS
All faucets and showerheads installed are listed in the Commission's Directory of Certified Faucets and Showerheads,
pursuant to Title 24, Part 6, Subchapter 2, Section 111.
' Signature Date Plumbing Subcontractor (Co. Name) or General Contractor or Owner
Revised January 1992
COMSTRUCTIOM COMPAMY
51960 AVENITA HERRERA
LA QUINTA, CALIFORNIA 92253
TOM HARTUNG
CITY OF LA QUINTA
78-105 CALLE ESTADO
LA QUINTA, CA 92253
DEAR TOM,
THIS LETTER IS A REQUEST TO EXTEND THE BUILDING PERMIT AT 51-665 AVENIDA
CARRANZA, LOT 14, BLOCK 56, FOR A PERIOD OF 60 DAYS.
SINCERELY YOURS,
MICHAEL DIETRICK
VeT)�L T^�, i�aslQY
TEL: 619.771-1561 FAX: 619-771-0572
RESIDENTIAL • COMMERCIAL • DESIGN • DEVELOPMENT
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 3/18/93 1 Type of Permit I La Quinta
No. 112090 1 Permit #
Owner Name Synercon Development Corp. Log
No. 51-665 Street Carranza
city La Quinta Zip 92253 Study Area 113
APN # I Tract # I J Lot # 0 Square Footage 11375
Type of Development I Single Family Residence No. of units 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 1 75 or $ 2,172.50 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
General Escrow
Name on the check
Telephone 568-3627
By lames E. Lively �;�f�:��{•
Assistant Superintendent, Business Services = `;� a� L `� ,'�•�; a
Fee collected /exempted by Marcia J. Ewart
Payment Re&ived
Signature g ��cJ ✓- ;
-`
rPheek- No X119903
Collector: Attach a copy of county or city plan check application form to district copy for a1 waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting