12119 (BLCK)P.O. BOX 1504
Building
Address 79-000 River Rock LA QUINTA, CALIFORNIA 92253
Owner
Synercon Development
Mailing
Address 94--940 Hwy 111, Ste. 429
City _ Zip Tel,, - .
Indian Wells, Cis 92210:7. - 564-6929
..Contractor
Address -
BUILDING: TYPE CONST. OCC: GRP_
A.P. Number
Legal Description - - • I
Project Description SS' of 4' high retainilig wall
.1601 of: tr' high buck gall
122' of .x' high 61.6ck gall
City
Zlp
Tel.
State Lic. 655280
City 2419
& Classif.
Lic. #
Sq. Ft. :
No. Nti.�Dw' '
'• B,'• - - •
Arch.Engr.,
Size
Stories Units':' •-----
,Designer
New ❑' ' Add ❑
Alter ❑ Repair ❑' '-,-Demolition ❑
Address
Tel.
'
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
- - -
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
of Divisi/on 3;ttof the Business and,Professions Code, and my license is in full force and
': x
,effect. . ! 1.,�` � - !C�,+�°,-•••t•, '
•
•
SIGNATURE_
DATE
' OWNER -BUILDER DECLARATION
I hereby affirm that I from the Contractor's License for
Estimated Valuation
! 10
am exempt Law the following
reason: (Sec. 7031.5,Business and Professions 'Code: Any.city orIcounty which requires a
permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance also
r:832.
••
requires the applicant for such permit to file a signed statement that he is licensed' pursuant to
PERMIT
AMOUNT
• 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 Section 7031.5 by 'any for
Plan Chk. Dep.
-
`
of applicant a permit
• subjects the applicant to a civil penalty of not more than five hundred dollars ($500). -
Plan Chk• Bal.
❑ 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
Const.
ctl� n
Professions Code: The Contractor's License Law does not apply to an owner or property who
builds or improves thereon and who does such work himself or through his own employees,
Mech.
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
Electrical
+
of proving that he did not build or improve for the purpose of sale.)
r
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
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:) -
S. M. 1.
,:� g0
Grading
5'
O I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
;Date owner
Infrastructure
' .•`-
• _- WORKERS' COMPENSATION DECLARATION
-.
"Whereby 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.)
ti
Policq� Company
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
93. U
CERTIFICATE OF EXEMPTION FROMr•_
WORKERS' COMPENSATION INSURANCE
REMARKS
'rr:r ru•a• :: _� I_"'[ CAS!_.^'7....C?`k
(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
Ty`e;�-:r r ,, o. W
-
employ become su
any person in any manner so as to bbject`to the l..orkerso. ensat
'Laws of California. _r f '•Cion
_
•�-y ��
-
Date_owne
• NOTICE TO APPLICANT.r If. after making this Certificate of—Exemption you should become •
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
fVlinimtim Setback Distances:
Front Setback from Center Line
+` ` • '.
Rear Setback -from Rear Prop. Line+
CONSTRUCTION LENDING AGENCY '7•-'`s% '" `
Side Street Setback from Center Line
1 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.)
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATEINSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
-
expiration it work thereunder is suspended for 180 days.
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I certify that I have read this application and state that the above information is correct.
Issued by:
Date Permit'
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 properly for inspection purposes.
Validated by:
Signature of applicant Date -
Mailing Address
Validation:
+ -.
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. I PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SO. FT. ®
WATER SYSTEM
URINAL
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(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE 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
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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. L �//�� //
!'
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 SIGNATURESIINITIALS
GARDEN WALL FINAL 77d