13211 (SFD)P.O. BOX 1504
Building 5360 �%lZ�r 78-105 CALLE ESTADO
Address ,LA QUINTA, CALIFORNIA 92253
Owner
Synercon Development
Mailing
Address 94-940 Rwy .111, Ste. 429
City Zip Tel.
Indian Wells, C,zk 92M 564-6929
Contractor
Same
City Zip Tela
State Lic. City
& Classif. B 655230 Lica 2419
Arch., Engr.,
Designer
Address Tel.
City I
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. /J is� J .% •, �... 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 rive 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 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.)
O 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 contractors) licensed pursuant to the Contractor's License Law.)
0 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.)
PolicyNo.r/r' .Company
j,Od y 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 lhp 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.
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. -. X32.11
BUILDING: TYPE CONST. OCC. GRP.,
A.P. Number 774-064-007
Lot -17 Block 205
Legal Description
SF D
Project Description
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Sq. Ft.���. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑
Demolition ❑
Permit does not include block wells or.:
pooh..
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date Permit
Validated by:
Estimated Valuation
$0.11,425.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan!'Chk. Bal. 1.
1480-84
Const.
Mech.
Electrical
Plumbing
S.M.I.
553.50
62.00
3.20.03
144.00
8.2.0
Grading ;r
20.00
Driveway En .ems '
GO
Infrastructur I ta
1,793.80
TOTAL
3,1117..37
REMARKS
23, 29-7
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. PLL
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
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
WATER HEATER SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. SO. 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
FREMARKS:,.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
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 ® 1+/a c
SEWAGE DISPOSAL
FINAL INSPECTION 9
SQ.FT.GAR ® 3/ac
HOUSE SEWER
1 /
CERT. OCC.
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 NDERGROUND
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) // 1 METER LOOP
`r J
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.
INAL INSP. %�
FRAMING _ 3 L
FINAL INSP.
ROOFING 01-16--1 Q L-9 Y1
[ J "J
- -
VENTILATION
FREMARKS:,.
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL`O
LATHING I Q �� —�
MESH
INSULATIONISOUND _
FINISG
FINAL INSPECTION 9
1 /
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated 619-775-3500 -
Date 8/9/93 Type of Permit La Quinta
No. 112366l Permit #
Log
Owner Name Synercon Development
No. 53-160 Street Avenida Villa
City La Quinta Zip 92253 Study Area 111
APly # 774-064-007 1 Tract # I Lot # 17 Square Footage 11400
Type of Development Single Family Residence No. of units 0
Comments
At the present time, the Desert Sands Unified School District does nmt 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 1.65 x 1400 or $ 2,310.00 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 ,�� ���: k ti
Assistant Superintendent, Business Services
Fee collected /exempted by Vickie J. Durrett
Payment,Recei'ged
. Signature
.� 7Check No. `1486
61
a
Collector: Attach a copy of county or city plan check application form to district appy for all�waivers-.
Embossed Original- Building Dept./Applicant Copy - Applicant/ Receipt Cop="«'A"c bunting
o '
i c4
CO -of a ONtlt�cl..
i ltt� tltl -ctltb �selfie t I- tIftkitiilt
This Certificate .issued pursuant to the requirements of Section 306 of the Uniform Building .
Code certifying that at the time of issuance this structure was in -compliance. with the, various
ordinances of the City regulating building construction or use. For the following:
V;
i
BUILDING ADDRESS
53- 160 Juarez
Use Classification Single -•Family - Dwelling • Bldg. Permit No. 13211
Group R3 Type Construction VN Fre Zone Use Zone SR I
Owner,,ot Building Synercon Development 94-940 Hwy 111, Ste. 429 ( II
Address
City4 Indian Wells, CA. , 92210
By;, nan,Pl P_ Crawfnrcl ,Tr_ Ij
i a Dote: May 1, .1995
—.
Building OfficialP0ST IN A•CONdPICUOUS' PLACI
y
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