12112 (SFD)P.O. BOX 1504
Building
Address 53-240 Juarez LA QUINTA, CALIFORNIA 92253
Owner
Synercon Development
Mailing
Address 74-940 HWY Ill
City Zip Tel.
Indian Wells., 92214 1 5646929
Contractor
Address
City Zip Tela
State Lic.. _ . City
&•Classif. - 655280. Lic.# 2413
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
#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. f 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
buildsor. 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.)
❑ 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 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 NNP!r .Company
f346opy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM -
WORKERS' COM PENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
of 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 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.
Iagree 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
No.
JILDING: TYPE CONST. OCC: GRP.;
P. Number 174-€141-$12
Description Lot. 13 Block 178
t Description $F
12112
Sq. Ft. 1778 No. No. Dw.'
Size Stories Units
Repair ❑
New ❑ Add ❑ Alter ❑
Demolition ❑
Permit does not include block walls or
Estimated Valuation $102,129.40
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
.S. M. 1.
Grading
Driveway Enc.
Infrastructure
Precise an
• t
AMOUNT
544.06
-.652.00
' 42.50
-133.73
141.00
14.30
20.00
0_
2,259.66
25.00
TOTAL 3,828.25
REMARKS
-_ f.._�. , .�.., r . • q•R� n s ^i,•v It �r �
I�t�r -CASH T'"TOTAL T`. ,�Efse.zs
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. PLUMBJNG FEES
IST FL. SQ. FT. ® $
UNITS
ROUGH PLUMB.
C
HEATING (ROUGH)
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
SEWER.08-661RT484"k(�
UGH WIRING
DUCT WORK
MOB]LEHOME SVC.
BAR SINK
POR. SQ. FT. ®
METER LOOP
HEATING (FINAL)
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. p
WATER HEATER
SERVICE
WALL SQ. FT.
DRINKING FOUNTAIN,
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
LUMBER GR.
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP._/l� l�L
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
I ILAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1114 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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 / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING �Y Lr%UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER.08-661RT484"k(�
UGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS(ROUGH) 3
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REIN F. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.B 2p,c� J 2
FRAMING �1 3 `
FINAL INSP._/l� l�L
ROOFING �j�— -C' 2 L�
l
Preul p 6 --ci—01 5 GAo
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
G -�-q3 �J
MESH
INSULATION/SOUND Z 3
FINISH GRADING
FINAL INSPECTION �I
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