11867 (SFD)Building
Address 54-800 Juarez
Owner Synercon Development
Mailin
Address 74-940 HWy 111
City - Zip Tel.
• Q�&4V
P.O. BOX 1504 N Q , 1 180
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
y BUILDING: TYPE CONST. OCC. GRP..-
A.P.
RP._A.P. Number 774-266-001.
Indiaix !!ILs*_L 9222 554-6929 Legal Description Asor- 24 ZIOCk 275
Contractor Project Description SPD
Sarre
Address
Zip Tel.'
State Lic. (City 2�l 9
& Classif. Lic. #
Arch., Engr., t
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
70 OO) of Division 3 of the Business and Professions Codec; and my license is in full force and
effect. /0 1 , X 7, ,°r
_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, andthe 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 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 No. 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 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 subject to the�Workers.'. Compensation
Laws of California.(j t
Date Owner b�-��r`-� . L R.Y u� `.I. + A 1 1.A ,
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
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
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
ateMailing Address
City, State, Zip
ZONE: '
BY:
Minimum Setback Distances:
Front Setback from Center Line
Sq. Ft.
Size . 2778
No.
Stories
No. Dw.
Units s .
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Permit doea
not include
block walls or
pool.
Date Permit
Validated by:
Validation:
Estimated Valuation
$IO2r,229.40
PERMIT
AMOUNT
Plan Chk:'Dep.
250.00
Plan Chk. Bal.
294.06
Const.
652.00
Mech.
42.50
Electrical
133.73
Plumbing
141.00
.S.M.I.
10.30
Grading
-20.00.
Driveway Enc.
Infrastructure
2,259.66
Arts in Publi_-
25.00
54
TOTAL f'
%8 :23`
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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES'
A.C. UNIT
COLL, AREA
SLAB GRADE
fa
1ST FL. SO. FT. ® $
UNITS
HEATING (ROUGH)
` ^ r w
FORMS
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
OTHER APP./EOUIP.
REINF. STEEL
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
WALL SO. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
SO. FT. ®
=$
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FRAMING 3 4P
WATER PIPING
NOTE: Not to be used as property tax valuation
Prea�P �// /s 5
YI�Y (7
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ec
HOUSE SEWER
FINAL INSPECTION
GAS PIPING -
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FErPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR GOND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL, AREA
SLAB GRADE
fa
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) /
i
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE 36h3
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
c • FINAL INSP-1e/—f3
FRAMING 3 4P
FINAL INSP.
ROOFINGGyink
VENTILATION 6
Prea�P �// /s 5
YI�Y (7
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING 3
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 2/25/93 1 Type of Permit La Quinta
No. 112040 Permit #
Log
Owner Name Synercon Development
No. Street See Below
City La Quinta tip 92253 Study Area 110
APN # Tract #I Lot # 0 Square Footage 13596
Type of Development I Single Family Residence No. of units
Comments 54810 Avenida Tuarez; 54800 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 3 596 or $ 5,681.68 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 Synercon Development Telephone 564-6929
Name on the check
By lames F. Lively
Assistant Superintendent, Business Services
Fee collected /exempted by Vickie J. Durrett
Payment Deceived
Signature
Check Np.2562/2608
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
SENT BY. XEROX Telecopier 7017; 2-23-93 9:57 ;
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6195646487;# 3
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COACHELLA VALLEY WATER DISTRICT
Remarks:
CASH RECEIPT DETAIL
Received From:
0 COPY to:
Q
Address:
'k
Account No. t6
Lots)
Service Address C o t U 0
Check
1 T -.-j 7 -t
111,46ter(s)
Money
�'tervlce(s)--
Order
0 Backflow(s)
0 House Lateral(s)
0 Detector Check(s)
0 Meter Surcharge
sanitation capacity Charge
0 W.S.B.F.C.
0 Temporary Construction Meter
0 Turn on Charge
0 Uncollected Account - Name
0 Inspection Fee - Tract -
Fee -
0 Plan Check Fees Water I Sewer -
Tract -
0 Bond Payment 7 A.D. -- Bond -
Assmt.
0 Customer Deposit
0 Other
Remarks:
0 COPY to:
Cash
Check
1 T -.-j 7 -t
Money
Order
Pia 423-11
Tract
G.A. Code
$
7
TOTAL $
Water Service
Cashier
CVWD-438 (11/89)