001710 (BLDG)Building
Address 77-550 e
Owner
iSAl9. IMd
Address P.O. BOX 1578
Tt, IOU
4ht 4 Q914A
P.O. BOX 1504 N o .
78-105 CALLE ESTADO
C3 LA QUINTA, CALIFORNIA 92253
CityZip Tel.
. �i�atn 93923 56 "446 , -
Contractor
.. Ludwxk Lard Omst. 03�.
Address
City Zip Tel.
Tia► 01inta 93923 345-28% _
State Lic. ICity
& Classif. 413636 Lic. #
Arch., Engr.,
Designer Ai 7>�rs
Address//�� qq���� Tel.
P.
City Zip State
r<1kl�ir 13��3 Lic. # C14006
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 Busihbss and Professions Code, and my license is in full force and
effect. �� O:d�ar. �/C,i, �+'✓f r..fr: Jc'...
SIGNATURE DATE
r- -OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractoes'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 thathe 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. 4044, 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 -h -
e 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 coniractor(s) 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.)
Policy No. Company '
O 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 ($100) valuation
or less.)
» I certify that in the performance of tha work for which this permit is issued, I shall not
+employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
subject" to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) .
Lender's Name
Lender's Address
This isa building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to -enter the above-
mentioned
bovementioned property for inspection_ purposes.
Signature of applicant Date
Mailing Address J A
City, State, Zip /
HARD COPY
001710
BUILDING: TYPE CONST: V OCC: GRP.
A.P. Number 052 P 001, .002s003sO4
Legal Description
Project Description T.A 01inta Golf nlll�� suncu=
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Sq. Ft. B%5450
Size R7n-
No.
Stories
No. Dw.
Units
NewSO Add ❑
Alter ❑
Repair ❑ Demolition ❑
FINAL:DATE
INSPECTOR
Issued by:
Date$ Permit
Validated by:
Validation:
A 2 6 0 7
9 16 1899,47. R
Estimated Valuation
150r4O.
PERMIT
AMOUNT
Plan Chk. Dep.
600.00
Plan Chk. Bal.
358.00
Const.
_
31„00
Mech.
135.04
Electrical
95.00
Plumbing
10.47
S.M.I.
Grading
20.00-
0.00.Driveway
DrivewayEnc.
11050.00 -
Infrastructure
TOTAL
2.4".e147
1.899.47
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:
A 2 6 0 7
9 16 1899,47. R
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. @
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. @
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT. @
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
SQ. FT. @
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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.
SQ. FT. @ c
BATH TUB
LATHING
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
FINISH GRADING
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 APP./EQUIP.
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:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS,
GARDEN WALL FINAL
rfl�i�zTVrtAL �W�2.S
-� l o�N. I�(P,I�w�k�;b IVa✓.
C714) 883-49774-
!-� �uinit� MaN'�t.1gNG6 �n��
5....:CEIVED
Jnr.
---r -----------McCORD & WALD
PALM SPRINGS
p4K(r, - $ -85
J�Nn goal ON= 17,0.
. I:� 4 Tre1155 t -I'm U —
ACTUw!rZw_ . ,
Of 9'e'.
� w �t—A L,
14' w foo*1I N1-
lot,
Y- l 4- bF ► r
K G0
ao*tt pts i
41
Essi
�`c• Q,RID C. F
� � l
IS 1 z �.-$ r 3077'
Wiz.- I,to�. ; M = 15'- �'� 7o8 ; As�- 1.�8(I G
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-- . �aF of CAS:
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vr, 2-f2
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be "�o' "/ ff o,2 " �� t /v �o5is
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tow�y as pwi � W/ rod
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Qom.
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tow�y as pwi � W/ rod
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9,347 t/AGL L/1J:�
UNDERG2 GOND TANK, 7 -RIM FDR GASOL 11VE WITH
001/ RLE WALL iAN�
- 2. 53 PA? -- /'/L.. 6,411. Ftogr VALVE
-L ryl4ivNn4c
_. :. .. %. L/145 -'F" FML RoifPY-aA[ (C.33T-4
-SU C 77DA/ pUAlp
8. /!/ Pp/►gFCo
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' t.� Qyc� IwrT/4 N TF eClc
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4
P.O. BOX 1504 APPLICATION ONLY
Building 78-105 CALLE ESTADO
Arirtrass LA QUINTA, CALIFORNIA 92253
Owner
ell, o
Mailing n
Address ASOY 1� A
City,
Zip
Tel.
_61 m4
�3��3
Sly/ , (/(/(5:,
Contractor
Li' 41,6 A"J7.Q e -r .
Address
City
Zip1� y� 52 3
Te� yS - 2 ?k
State Lic.
& Classif. y� 3� 3 6
City
Lic. #
Arch., Engr.,
Designer
Address TTel.
City Zip State
1e' ao/w 7,o���r Lic. # iy�6
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000)
t. of Division 3 of the Business and Professions Code, and my license is in full force and
effec
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, eller, 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) of
Division 3 of the Business and Professions Cade, 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 penahy of not more than five hundred dollars (5500).
❑ 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.)
❑ 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 pro/acts 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 ($700) 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, alter 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.)
Lenders '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
BUILDING DIVISION
BUILDING: TYPE CONST. -0 OCC. GRP.
A.P. Number # 773(1)-.-72
3%1..2
t'15� C11x?'
Legal Description'/0 7' /3, i; /.
,LA T u/!ir
Project Description
1a f,?i'i.r��i (0/7� /%2•�i/�Tr/�ti�vCE �triLG';
Sq. Ft. P D 10 No. / No. Dw. 4.1;Size C Stories ' Units
New4 - Add ❑ Alter ❑ Repair ❑ Demolition ❑
77L6
Estimated Valuation
PERMIT AMOUNT
Plan,Chk. Dep..-
Plan Chk. Bal.
Const.- C3S0
Mech. —
Electrical 5 -
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure acoo, 2!yn
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:
A 1 7 5 5 6 26 600.00 CK
CONSTRUCTION ESTIMATE
GROUND PLUMBING
UNDERGROUND
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. d00 SO. FT. ® Q
$ .CiI Q,
BONDING
UNITS
STORAGE TANK
FORMS
(y
2ND FL. Q SO. FT. ® 1- L
S 1 on
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
YARD SPKLR SYSTEM
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
MOBILEHOME SVC.
BAR SINK
GROUT
POR. SO. FT. ®
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GAR. SQ. FT. ®
_$
LUMBER GR.
POWER OUTLET
FINAL INSP.
ROOF DRAINS
FINAL INSP.
ROOFING
DRAINAGE PIPING
CAR P. SQ. FT.
FIRE ZONE ROOFING
WALL SQ. FT.
FIREPLACE
DRINKING FOUNTAIN
SPARK ARRESTOR
SO. FT. ®
GAR. FIREWALL
URINAL
ESTIMATED CONSTRUCTION VALUATION
$ I q(4 XOO
WATER PIPING
INSULATION/SOUND
NOTE: Not to be used as property tax valuation
FINISH GRADING
FLOOR DRAIN
MECHANICAL FEES
CERT. OCC.
WATER SOFTENER
FENCE FINAL
VENT SYSTEM FAN EVAP.COOL HOOD
G
SIGN
WASHER(AUTO)(DISH)
GARDEN WALL FINAL
APPLIANCE DRYER
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
'%
OQ
AMPERES SERV ENT
`00SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
S
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
0G
PERMIT FEE
to
PERMIT FEE
to
DBL
TOTAL FEES
MICRO FEE
MECH.FEE
PL.CK.FEE
CONST. FEE
ELECT. FEE
SMI FEE
PLUMB. FEE
`�
1 SS
I k
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 APP.IEQUIP.
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:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL