12075 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 53-'230 Juarez LA QUINTA, CALIFORNIA 92253
Owner
Synercon Developmnt Corp.
Mailing
Address 94-940 HWY Ill
CityZip Tel.
Indian ,,Tells, 92210 5649-6929
Contractor
Sate
Address
- ITeI.
Statei. 655280 (City 2419
& Classit. 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. 114 -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 oricounty 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 theBusiness 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 o1 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 notapply 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.)
❑ 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 ,%.
i
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.)
Policya Company
L� I?1 py 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 the work for which,this permit is issued, I shall not
employ any person in any manner so as to become slubja6t to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT., If, alter making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must torthwith
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 it work thereunder is suspended for 180 days. 't
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 f'
City, State, Zip
No. 12075
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number 774-041-011
Legal Description Lot 14 Block Sig
Project Description Ste%
REMARKS
Sq. Ft. 1818 No.
Size Stories
No. Dw. ;
Units
New�'li Add 0 Alter ❑
Repair ❑ Demolition ❑
Perrait does not ,include
block walls or
pool.
Estimated Valuation
$107, I47. a4
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
559.53
Const.
667.50
Mech.
.49,50
Electrical
135.53
Plumbing
144.00
S.M.I.
10.80
Grading
20.00
Driveway Enc.
--0--
Infrastructure
2015.10
Arts in x Places
25.00
TOTAL
,9x6.
3,926096 -
REMARKS
au •wri a Y�'Y *ec.. • v�u. �.y
ZONE:—_ . —BY:
Minimum SetbDistances:
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 ,r
1ST FL. SQ. FT. ® $
UNITS
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
REINF. STEEL
GAS (FINAL) TEMP. POLE 4 3
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
WATER HEATER SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. SQ. FT. ®
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
WALL SQ. FT.
LUMBER GR.
DRINKING FOUNTAIN.
SQ FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L 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,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 ® 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 LPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE 00' PLUMBING ` ( ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING 2 UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE 4 3
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
- FINAL INSP. jor.Z(—�y
FRAMING �jJ (n
FINAL INSP.
ROOFING
6—(���i3' d
1r (JIO
Foart A3 GP
REMARKS: '
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL 23
LATHING — 2
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
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 1 Type of Permit I 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 564-6929
Name on the check
By lamps F. Livp]v
Assistant Superintendent, Business Services
Fee collected /exempted by
Tomi Doebereiner
Payment Received
Signature ,,lL(
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
RECORDING RTvuets'rav Dr
ANO,WH91V pttORD[O VAR, 71418 DIED ANO, UNL9"
OTHERWID9 *MOWN ocLOW, MAIL TAX aTATLMENTO TO:
MAN[ 1
Aoa■[■■
an;
OTAY■
sir L
SYNERCON DEVELOPMENT CORP. 1
74-940 EIM 111, STE 429
INDIAN WELLS, CA 92210
I
INSTRUMENT # 122465
RECORDED : APRIL 1, 1993
Title Order No,.197.2099...... Escrow No..10.-.1.69.33. w Thia
Grant' eed
N
ufe
.THE UNDERSIGNED GRANTOR(s) DECLARE(a) 26.40
DOCUMENTARY TRANSFER TAX is S
p —unincorporated area City of LA QUINTA
Parcel No, 774-171A — 11
)Q computed on full value of property conveyed, ur
❑ computed on (uli value less value -of litn6 or encumbrances remaining at time of slit, and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged,
PETE ORTIZ AND PAT ORTIZ, HUSBAND AND WIFE AS JOINT TENANTS
hereby GRANT(S) to
SYNERCON DEVELOPMENT CORPORATION, A CALIFORNIA CORPORATION
the following described real property in the CITY OF LA QUINTA
county ;of RIVERSIDE . , State of California:
LOT f'4 IN BLOCK 178, OF SANTA CARMELITA AT VALE LA QUINTA, UNIT NO. 18,
AS SHOWN BY MAP ON FILE IN BOOK 19 PAGES 30 AND 31 OF MAPS, RECORDS OF
RIVERSIDE COUNTY, CALIFORNIA„
State of CALIFORNIA
t
County Of� RIVERSIDE )
On 3-5-93 before me, MICHELE J. HARTSHORN, NOTARY PUBLIC
. DATE NAK TM.! OF OMCER • E.(i`.'AANE DOE. NOTARY ROW
CAPACITY CLAIMED BY SIGNER
(n INDIVIDUAL($)
❑ CORPORATE—
OFFICER(S).
ORPORATE—OFFICER($)
TtTLE(a)
❑ PARTNER(S)
ATTORNEY-IN-FACT
Q TRUSTEE(S)
Q SUBSCRIBING WITNESS
Q GUARDIAN/CONSERVATOR
C OTHER:- —
SIGNER IS REPRESENTING:
NAML OF PFRSON(S) OR ENTITY(IES)
r
ATTENTION NOTARY: Akhouph the IMortnatlon r blblw Is 0 0 AL,h couldprevent fraudulent attaCAmont of this cortlllcate to unnuft zod documentTHIS CERTIFICATE Title are of Document GRANT DEED
MUST BE ATTACHED ' Number of Pages hate of Document,, -5-93
-TO THE DOCUMENT
DES&IIBED.AT RIGHT: Signer(s) Other Than Named Above
b 1991 NATIONAL NOTARY ASSOC1AT10N • W6 PAmmwt Ave. - P.O. that 7164 • tdflopa P■rt< QA 9t3D4.716�
9 #"Leteve 9619 +-96zeLvt6l9 E1;01 E6;EZ-b :EIDE Jaidoaalal X083X .,19 1N3S
personally appeared PETE ORTIZ AND PAT ORTIZ
NAME(8) OF SIGNERl81
❑ personally known to me - OR - ® proved to me on the basis of satisfactory evidence
to be the person(s) whose name(s) Aare
subscribed to the within. Instrument and ac-
_
knowledged to me that Mls"Ahey executed
the same in hig/h�Vtheir authorized
capacity(tes), and that by' */h�ltheir
MICHELE J. WUtTSHORN. signatVre(s)-on the instrument the person(s),
' "
- ,
COMM: tt9ti�34d
+• =�r .Notary Public-CoNfomlc or the entity upon behalf of which the person(s)
` _ RtVER3IDE:COVNTy _ �__- acted;. xecuted-the instrument.
MY comm, expires JtIN 07,144$ Witness my hared ano;xMlal p'�''
CAPACITY CLAIMED BY SIGNER
(n INDIVIDUAL($)
❑ CORPORATE—
OFFICER(S).
ORPORATE—OFFICER($)
TtTLE(a)
❑ PARTNER(S)
ATTORNEY-IN-FACT
Q TRUSTEE(S)
Q SUBSCRIBING WITNESS
Q GUARDIAN/CONSERVATOR
C OTHER:- —
SIGNER IS REPRESENTING:
NAML OF PFRSON(S) OR ENTITY(IES)
r
ATTENTION NOTARY: Akhouph the IMortnatlon r blblw Is 0 0 AL,h couldprevent fraudulent attaCAmont of this cortlllcate to unnuft zod documentTHIS CERTIFICATE Title are of Document GRANT DEED
MUST BE ATTACHED ' Number of Pages hate of Document,, -5-93
-TO THE DOCUMENT
DES&IIBED.AT RIGHT: Signer(s) Other Than Named Above
b 1991 NATIONAL NOTARY ASSOC1AT10N • W6 PAmmwt Ave. - P.O. that 7164 • tdflopa P■rt< QA 9t3D4.716�
9 #"Leteve 9619 +-96zeLvt6l9 E1;01 E6;EZ-b :EIDE Jaidoaalal X083X .,19 1N3S