10434 (SFD)Building 53-830 Herrera
Address
Owner
Synercon Development cope
Mailing
Address 74940 Hwy 111. OS429
City Zip Tel.
India' n Wells 9224.0 1771-3
Contractor
Pelletier vonstructiori
Address
74641 Sweetwell Rd
City Zip Tel.:
1009 Palms 92276 567 -
State Lic.. City
& Classif. 260484 Lic. #
Arch., Engr.,
Designer David Dietx'ick
P.O. BOX 1504 " j No. 10434
78-105 CALLE ESTADO 1
LA QUINTA, CALIFORNIA 922,153
BUILDING: TYPE CONST. OCC: GRP.
Address Tel.
.45320 Driftwood Dr 341-1426
City Zip State
'Paha. Desert 92260 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 isin full force and
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SIGNATURE T "" DATE
V OWNER -BUILDER DECLARATION1.
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, 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 or 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 I
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 thg work for which this permit is issued, I shall not
employ any pperson in any ma her so as to',become3subject to the Workefs' Compensati'ori
Laws of -Cali fornia. i:ir e' ift,.•9i if ? t i .. t
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 orrthis 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 Address
City, State, Zip
A.P. Number
Legal Description
Project Description
SFD
Sq. Ft.��� No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Permit does not include any block
walls or cool
Estimated Valuation
86:459.30
PERMIT
AMOUNT
Plan Chk. Dep.
250.00 A
Plan Chk. Bal.
246.15 k -4
Const.
2-04 A?>f (
Mech.
1�6S
Electrical
2� 1,21 -
-Plumbing
Plumbing
S.M.I.
.. $.70
Grading
2-�'. 00
Driveway Enc.
20-.00
Infrastructure
1907.76.
r
-
TOTAL
4,2�. Q*e
REMARKS
nfi:1; 6 A'9 i It AL'dai'� etf �••�t'3�-�? S.i~i'
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
IST FL. SO. FT. ® $
UNITS
SLAB GRADE /
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER OR SEPTIC TANK
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO, FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
OTHER APPJEOUIP.
DRAINAGE PIPING
WALL SO. FT.
TEMP. POLE
DRINKING FOUNTAIN.
SO FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
_$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
O�Q ^
//✓ i ( T
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
GAR. FIREWALL
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1//a c
SEWAGE DISPOSAL
SO.FT.GAR ® Vac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK W/17 0%/
GROUND PLUMBING/*f
DERGROUND
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 �� Z
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
n
FINAL INSP.3 4�
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FRAMING �"(� 7�
FINAL INSP.
ROOFING /La 1[�GIb/
( /
O�Q ^
//✓ i ( T
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
WING t (�
MESH
INSULATION/SOUNDQ-10 9.2
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINRIALS
GARDEN WALL FINAL
TAf °f �Qurxrw
P.O. sox 1W4
76105 CALLE ESTADO
LA OUINTA. CALIFORNIA 9225
Contractor owner
Address
Job Address
La Quinta City License No.: Expires: Bldg. Permit No.:
This form shall be posted on the job with the Building Inspection Card and it
shall be the duty of the General Contractor or if Owner -Builder Permit, the owner
to see that all sub -contractors sign this card, giving his City of La Quinta
Business License Number, Contractors License Number and a current certificate
of Workman's Compensation Insurance Certificate when he starts the job. Failure
to comply may cause Building Inspectors to stop work, or complaints to be filed
against such contractors or owners.
CITY CONT.
SUB -CONTRACTORS NAME LIC. NO. EXPIRES LIC. NO. EXPIRE:
301
3a 33
DO NOT.REMOVE THIS CARD
Before Final. Building Inspection Will Be Made
T is C.-- U,,ct Co In.. ..feta! and Ci1orl With Trio 4 r`-1
Grade i Excavate
2..
Pipelines
CpCement
-Foundations
�N lV 6t-
4.
Cement Walks i Drives
5.
Asphalt Paving
Framing
7.
Steel Structural
8.
Masonry
Plumbing
_
to.,
Lathing
11.
Drywall
L2.
Plastering
HVAC
240
l4
Electrical
�5urc.
L5.
Roofing
L6.
Sheet Metal
17.
Floors -All Types
18.
Glass - Glazing
19.
Insulation/weatherstrip
20.
Sewage Disposal
21.
Painting/Decorating
22.
Tile
23.
Cabinets -Installations
24.
Ornamental Metal
25.
Fences/Blockwalls
26.
Landscaping '
27.
Others
28.
301
3a 33
DO NOT.REMOVE THIS CARD
Before Final. Building Inspection Will Be Made
T is C.-- U,,ct Co In.. ..feta! and Ci1orl With Trio 4 r`-1
if
Buildind
Address 5)Q A
Owner
' SYxlek C o Al, 10,4-116:1 QP 6J A)
Mailing ,f 1-1141P
�/ �/
Address 7� — Y-�%`� /7 �J s
City Zip Tel.
N ,ur- uoCIO- AiS
i
• Contractor .4
Address
_ 7
City 3 Zip Tel.
1� o �ALr� �G e /q— S-/
State Lic` City
& Classif.`AvehrrEng6o Jl �g Y Lic. #
..
Designer
Address.
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