14199 (SFD)-`4 44
hfQUM&
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P.O. BOX 1504 No. 14199
1 V V
Building 78-105 CALLE ESTADO
Address 54-810 Ave. Juarez LA QUINTA, CALIFORNIA 92253
Owner
James L. Montgomery VN
BUILDING: TYPE CONST. - OCC. GRP..
R3
AddreMailinss 774.266-€302
A.P. Number
City Zip Tel. Litt 23 Block 276
Legal Description
Contractor SPEC
owner/Builder, Project Description
Address
Contractor change see permit 411868
Zip Tel.
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
AddressTel.
CityI Zip I 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 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).
❑ 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.)
41=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
j
i6 fl ,%fie , c Air.. _.. -��'+ r e�. "-
_{Date Owner r
�" 'r
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 tho 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.f
Date f "!,OC 1"l -_V? r
Owner
iypTICE TO APPLICANT: If,.aRer making this Certificate of Exemptionyou should become
ubject 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 slate 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
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:
Sq eFt. 1818
No: No. Dw.
Stories • Units
New ❑ Add ❑
Alter ❑ •Repair ❑ Demolition ❑
Permit does
,not include block walls or.
pool.
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep. '
Plan Chk. Bal.
Const
-
Mech.
Electrical
Plumbing
.S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
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 SES
1ST FL. SO. FT. ® $
UNITS
�
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SO. FT.
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (FINAL)
TEMP. POLE
WALL SO. FT.
DRINKING FOUNTAIN.
SO FT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
REMARKS:
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
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 C
SEWAGE DISPOSAL
INSULATIONISOUND
SO.FT.GAR ® 3/aC
IHOUSE 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
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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
FINAL INSP.
ROOFING
REMARKS:
D ,, -t I w.
VENTILATION
FIRE ZONE ROOFING
fS
FIREPLACE
� S
SPARK ARRESTOR
GAR. FIREWALL
LATHING
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 I La Quinta
No. 112040 Permit #
Log
Owner Name Synercon Development
No. Street See Below
city La Quinta Zip 92253 Study Area 110
APN # I = Tract #I = Lot # 0 Square Footage 13596
Type of Development I Single Family Residence No. of units 0
Comments 54810 Avenida Tuarei 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 James E. Lively
Assistant Superintendent, Business Services''
Fee collected /exempted by Vickie J. Durrett r
Paymenf,F:pceivj d{
Signature C�ZkR�p/?/1 r ''+• Check No" 2562/2608
Collector. Attach a copy of county or city plan check application form to district'cupy}},fpr: all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/ Receipt Copy - Accounting
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FOR A VALi111MS COM1SIOMAIMN, 1=k3 of alst+h b Icy t akdCd,
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titles 0 4fO�I A CEL�atIiA A41tiXs
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to 0 (h0 pemen(e) When namo(e) attire
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knowadpcd to tn3 thal h*hefty enoWed
the soma M hls/h'orithnir oatherillod
coaaaity(ios), and tndt by MelhoMhoir
114palwo(a) on the ftthvni*rn tho paraon(C).
a th a chry upon b2hat(ntyrhleh the paraon(a)
acted, 636Cu1615 the Mattuwt.
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THIS WRTIFICATE Tttte or Type pt DGOWMOM �, . , •
R ' MUST BE ATTACHED
TO THE DtaCWA[NT Number pt Paoli Dale of DooUm11n1
1•
010MIND AT RIGHT: Signers) Other Thin N 40 App"
6AL,1A.I Vow A'IIIIi
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL4?
L
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� c u. t' t % �r � I`t is V l l! i1
`-�' � 'amu �l
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� al
. Received From: �
.� y G�.
Date:
Address: S — Jy - I.1 l ct �t. ��'`'
f Y►'�V. C.f t�.�
C� C [1
Account No. Lo o b ` �" a In 0 ° _`� - - . Lots)
— �,
ti--- Sract
S
Service Address 4 L4-- c y-` 1 A i -.J
u-4 i ti
G.A. Code
C9 Meter(s) _ /
$ L .�
131,,9ervice(s) i
❑ Backflow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
- ❑ Meter Surcharge
- anitation Capacity Charge
s._
�-
-y
❑ W.S.B.F.C.
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
❑ Inspection Fee - Tract -
Fee -
❑ Plan Check Fees Water I Sewer -
Tract -
❑ Bond Payment - A.D. - Bond
Assmt.
❑ Customer Deposit
❑ Other
TOTAL
$ �� 'D S c i
Remarks:
❑Copy to:
Cash
Water Service
Check
MoneyI
Cashier )
Order
CVWD-438 (11189)
Installation Certificate: Residential CF -6R
Use of this form to satisfy the requirements of the Administrative Code Is optional, but the Information must be provided and posted.
Site Address Permit Number
An installation certificate is required to be posted at the building site prior to the issuance of the occupancy permit. This form
may be used to meet these requirements. All appliance categories listed below are the actual equipment instafled. Note that
the efficiency and type of the appliance installed must be equivalent or better than the appliance specified on the Certificate of
Compliance (CF -1R). This certificate (or its equivalent) shall be prepared and signed by the person(s) assuming overall
responsibility for the appliance installation.
I, the undersigned, verify that the equipment listed in the category above my signature is the actual equipment installed and
that the equipment meets or exceeds the requirements of the Appliance Efficiency Standards. In addition, I have verified that
the equipment is equivalent to or more efficient than the equipment specified on the Certificate of Compliance submitted to
demonstrate.compliance with the Energy Efficiency Standards for residential buildings.
HVAC SYSTEMS
Note: Hydronic boiler information is entered here. Other hydronic or combined hydronic equipment is listed under
Water Heating Systems.
Heating Equip. CEC Certified Actual Distribution Duct or Heating Load Heating
Type (furnace, Manuf. Make & Efticlency Type and Piping Before Over- Equipment
heat pump, etc.) Model Number (AFUE, etc) Location R -Value Sizing (Btuh) Capacity (Btuh)
a(=W-CPt)fVT it j�ca 23�:r�
PfIC. E fLP I� G �i i 3S — T S L '
(a` Cot'
CEC Certified
Cooling Equip. Compressor Unit Actual Distribution Duct or
Type (air Gond., Manuf. Make & Efflclency Type and PI Ing
heat pump, etc.) Model Number (SEER) Location R -Value
NCATe° I IA P �9 E s<4VA • 00 CLASS Ft_E )L s, Z
t�PNp 01t3S
The building design heat loss and design heat gain rate have been determined using a method specified in Section 150(h) of
the En y Effi ' cy Standards, and are two of the criteria used for equipment sizing and selection.
Signature Date HVAC Subontractor (Co. Name) or General Contractor or Owner
WATER HEATING SYSTEMS
• Energy' External
Water Heating CEC Certifled Rated' Tank Factor or Tank
System Type Manuf. Make & Input (kW Capacity Recovery StandbyInsulation
(storage gas, etc. Model Number or Btuh(gallons) Eff Icloncy Loss % R -Value
1. For small gas storage (rated inputs 75,000 Stu/hr), electric resistance and heat pump water heaters, list Energy Factor.
For large gas storage water heaters (rated input >75.000 Btulhr), list Rated Input, Recovery Efficiency and Standby Loss.
For Instantaneous gas water heaters, list Rated Input and Recovery Efficiency.
For Instantaneous electric water heaters, list Rated Input.
FAUCETS & SHOWER HEADS
All faucets and showerheads installed are listed in the Commission's Directory of Certified Faucets and Showerheads,
pursuant to Title 24, Part 6, Subchapter 2, Section 111.
' Signature Da Plumbing Subcontractor (Co. Nam or General Contractor or Owner
Revised January 1992