11868 (SFD)fi t
Building
Address 54-210 -'Juarez
4
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Owner
Synercon Development
Mailing ..
Address 74-940 - til
City Zip Tel.
Indian Wells, 92210 564-°6929
Contractor
Same
Address
CityIZip I Tel
State Lid. " City 2��
& Classif. Lic. #
Arch., Engr., -
Designer
Address- Tel.
City I 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.
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 orlcounty 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 rile a signed statement that he Is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
Division 3 or 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 thework, 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
or proving that he did not build or improve for the purpose or sale.)
'0 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
d r: ' a
Date Owner? a A 1..0
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
0 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be complete d,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
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 it 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
No. 11868
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number 774-266-002
Legal Description Loi' 23 Block 276
Project Description S'i3
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:
e
Sq. Ft.
Size
No. No. Dw.
Stories Units
New CK Add ❑
Alter ❑ Repair ❑ -Demolition ❑
Permit does
not include dock walls or
P001;
Estimated Valuation
$107,147.00
PERMITA
MOUNT
Plan Chk.'Dep.
Plan Chk. Bal.
659.53
Const.
= 667.50
Mech.
49.50
'Electrical
t .133.53
Plumbing
144.00
S.M.I.
11.80
Grading,
20.00
Driveway Enc.
Infrastructure
2, 315 , 10 "
t& in Public 25.00
!3T �}r�y/t 71+,7
v L 3'iMa Ty i i }e i 1 .�s9Ft
1
TOTAL
-3,36-646
REMARKS%+t
fn
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:
e
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING
r c�>h
IST FL. SO. FT. ® $
UNITS
ROUGH PLUMB.
°►._,
C r r r
T
ANK
ffSTORAGE
YARD SPKLR SYSTEM
SEWER OR SEPTIC TANK
2ND FL. SQ. FT.
DUCT WORK
FOUND. REINF.
GAS (ROUGH)7Q L
7 (
MOBILEHOME SVC.
BAR SINK
OTHER APPJEQUIP.
POR. SQ. FT. ®
GAS (FINAL)
TEMP. POLE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
SERVICE
FINAL INSP.
DRAINAGE PIPING
WATER SYSTEM
CAR P. SQ. FT. ®
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
WALL SQ. FT.
FRAMING f343(p
DRINKING FOUNTAIN.
ROOFING96 3
VENTILATION
SQ FT ®
URINAL
REMARKS:
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FIRE ZONE ROOFING
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
THING
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
INSULATIONISOUND
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
/
FINAL INSPECTION
'
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH' TUB
INSPECTOR'S SIGNATURES/INITIALS
SQ. 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
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
A
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
ANK
ffSTORAGE
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
FOUND. REINF.
GAS (ROUGH)7Q L
7 (
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 f343(p
FINAL INSP. I
ROOFING96 3
VENTILATION
^^,,�
p
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING
MESH
INSULATIONISOUND
FINISH GRADING
/
FINAL INSPECTION
'
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL