12113 (SFD)Building
Address 53--220 Juarez
Development
P.O. BCX 1504
78-105 CALL -E ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 74-940 HWY 111
City lZip Tel.
Indian W6113, VA 92214 564-6929
Contractor
City
State Lic. 555280 (City 2415
& Classif. Lic. #
Arch.,'Engr.,
Designer
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
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.., ,
I 44 .4 ' F'
'_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, I 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 penally of not more than five 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, 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, 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 or property who buildsor improves thereon, and who contracts for
such projects with contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
No. 12113
BJILDING: TYPE CONST. OCC. GRP.
A P. Number 774--041--010
Legal Description' Lot 15 Block 178
Project Description . • SM
Sq. Ft. 281Lg No. N'o. Dw.
Size Stories Units
New C Add ❑ Alter ❑ Repair ❑ -Demolition ❑ ti
Permit .does not include block walls or
pool.
Estimated Valuation $107 r 147 . 00
PERMIT
Plan Chk. Dep. '
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Date owner Infrastructure
e i
Till
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 Ncl!' Company
Cg1�Copy is filed with the city. ❑ Certified copy is hereby furnished.
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 so as to become subject to -the Workers' Compensation
Laws of California.
Date Owner f fl y
'NOTICE TO APPLICANT: if, after making this Certificate or 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
em
TOTAL
AMOUNT
- z
559.53
667.50.5
.47..50
1,35.53
144.0€
10.8q}0
20.00
-0-
2,315.10
25..00
REMARKS
..� i �Y��i�iri'i) 4�•d L11 ±"if._ �,Y, •_�3+�y r�ii's. �!?4.211
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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
ROUGH PLUMB. -BONDING
~ r
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
SEWE UGH WIRING
DUCT WORK
ROCK STORAGE
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
HEATING (FINAL)
OTHER APPJEQUIP.
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GROUT
DRAINAGE PIPING
CAR P. I SQ. FT.
BOND BEAM
WALL SQ. FT.
GRADING
cu. yd.
$ -Plus-X$-=$
DRINKING FOUNTAIN.
SQ FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
ROOFING, �2�(5 +%
WATER PIPING
NOTE: Not to be used as property tax valuation
REMARKS: -e
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
LAUNDRYTRAY
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FINAL INSPECTION
SO.FT.GAR ® 3/4c
HOUSE SEWER
CERT. OCC.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE
LE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK If
10, GROUND PLUMBING ,2 4ANDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE (217
ROUGH PLUMB. -BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
\\
V
SEWE UGH 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 � "!q-13 00
FINAL INSP.
ROOFING, �2�(5 +%
/►
(/
�CQr,JY�ln ��! / dJ
^
c( (.n 6-(1dg3&-n
li Cjp
REMARKS: -e
t r
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
.GAR. FIREWALL�� - )3 f�V
LATHING
MESH
INSULATIONISOUND 2
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 4/23/93 Type of Permit La Quinta
No. 112162 Permit #
Log
Owner Name Synercon Development Corp
,No. Street See Below
City La Quinta zip 92253 Study Area 111
APN # Tract # Lot # 0 Square Footage 15414
Type of Development Single Family Residence No. of units 0
Comments �53=220 Avenida Tuarez, 53-230 Avenida Tuarez, 53-240 Avenida Tuarez
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 5 414 or $ 8,554.12 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 . David Dietrick Telephone
Name on the check
By Tames E. Lively
Assistant Superintendent, Business Services
Fee collected /exempted by
Tomi Doebereiner
Signature
_�u L L I
Payment Received
Check No. 646
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
r
11
RECORDING REQUESTED By
AND WHEN RECORDED MAIL THIS DEED AND, UNLRSB '
OTHIERWIBE 6HOWN BELOW, MAIL TAX ATATEMENTS TO,
tlAwe r SYNERCON DEVELOPNEN'J' —1INSTRQilIIENT # 141955
tuner? 74-940 HICEWAY 111, SUITE429 RECORDED = APRIL 16, 1993
AODRii{ INDIAN WELLS, CA. 92210
CITY, ATTN: MARK ABRAMS y.
ETAT[1 J ,
ilr
Tide Order No..1972100...., E)crow No..10.-16938
T ce for Recorder's use
orant Deed
THE UNDERSIGNED GRANTOR(s) DECLARE(s)
DOCUMENTARY TRANSFER TAS( is $ ZK- AQ -
E) —unincorporated area ❑ City of
Parcel No,
2 computed on full value of pnperty con4eyrd, ur
❑ computed nn full value les. value of liens or encumbrances remaining at time of sale, and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
.PETE ORTIZ AND PAT ORTIZ, HUSBAND AND WIFE AS JOINT TENANTS
hereby GRANT($) to
SYNERCON DEVELOPMENT CORPORATION , A CALIFORNIA CORPORATION
the following described real property in the CITY CF LA QIIINTA,
county of RIVERSIDE , state of California:
LOT 15 IN BLOCK OF SANTA CARM$,ITA AT 'VALE LA QUINTA, UNIT NO. 18, AS SHOWN
BY MAP ON FITS IN HOOK 19 PAGES 30 AND 31 OF MAPS, RECORDS OF RIVERSIDE
COUN'T'Y, CALIFORNIA.
IS
rr.
Dated MARCH 18, 1993
- --Z
STATE OF CALIFORNIA t
f COUNTY OF J S'S' PAT ORTIZ ;r-- °rte
On -- -- - before Y+e,�
a Notary Public in and for said County and State, personally appewed
personally known to me (or proved to me on.tho'basls of satisfac,-.ory
evidence) to be the person(s), whose names) Is/are subscribed to the
within Instrument and acknowledged to me that he/shefthey executed
the same In his/her/their authorized capaelty(ies), and that by hislherMelr
signature(s) on the Instrument the person(s), or the entity upon beialf
of which the persons) acted, executed the Instrument.
WITNESS my hand and official seal
Of
Signature
FOR NOTARY SEAL OR STAMP I
MAIL TAX STATEMENTS TO PARTY SHOWN ON FOLLOWING LINE; IF NO PAR'T'Y $O SHOWN, MAIL AS DIRECTED ABOVE �
Name Street Address City & State
CTC•1.101 (9-91)
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