04-5616 (SFD)YK1.
BUILDING & SAFETY DEPARTMENT
P.O. Box..1504 (760).777-7012
-797-4-95 AE. TAMPICO FAX (760) 777-7011
LA-QUIN , CALIF`ORNIA 92,253 INSPECTION REQUESTS (760) 777-7153
0 4` 2004 BUILDING PER
U . Huv - - .. • -_ ,MIT
CITY OF LA ®UINTA -- -
App L atsior N m�ber
0A---&0i00,5,�16 Date 7/23/04
Property Address.,. 575.1.3 SANTAROSA TR
APN: 762-240-013'-17 -30487 -
Application deser pts on DWELLING; S`INGLE.FAMILY DETACHED
Property, Zoning:,... LOW, DENSITY RESIDENTIAL
Application.. -valuation 168844
Owner
Contractor
SANTA ROSA.DEV
GREYHAWK, INC.
40847 SANDPIPER CT
1603 TkkSK ROAD.
PALM DESERT.
CA 92260 ENCINITAS -
CA 92024
(,7§.0)-;:,.634;._'l 0'31
WCC.:: EXEMPT.;
WC: EXEMPT
1'0/21/04
CSLB;.. 7.98`228,.
08/31/05
CCC B
------------=-=-----------
Structure,,-I'nf'ormatio'n' . --- ,---
. ^------------
Construction Type . .
. . . TYPE N - NON RATED
Occupancy Type`.. . . .
. . .' D.WELLG/LODGING/GONG <=10
Flood Zone . . . .
NON -AO FLOOD ZONE
Other struct info
CODE -EDITION
2-0-01 CBC .
# DROOMS '
4. 0 0
FTRE;.;SPRINKLERS
NO
GARAGE -SQ FTG
809.00
P,.,_ATIO..•;SQ FTG
,
394.00
. , NUMBER OF UNITS.,..:
1.00
FLRST`:FLOOR SQ FTG
258.3.00
Permit . ... .'
BUILDING PERMI,T
_
Additional desc
Permit Fee .
881.00 Plan -Check Fee
143.16
Issue Date
Valuati.bh
168844
Qty Unit Charge-
Per-
Extension
BASE FEE
639.50
69.00 3.5000
THOU BLDG 100,001=500,000.
241.50
Permit
MECHANICAL
Additional desc..; ;:-
Permit Fee
108.00 Plan.Check,Fee
6.75
Issue Date
Valuation'`,
0
Qty Unit Charge
Per.
Extension
P.O. BOX 1504 •
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Seo/�o ]—.Architect
Date: SSSApplicant: or.Enaineer: A
Applicant's Mailing Address:
No.: 0 f __0
BUILDING PERMIT DECLARATIONS
Address:
?f
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm.under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and Lic is in full force and effect. 7
/ License Classss cense No. !/
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she 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 ciyil penalty of not more than five hundred dollars ($500).):
U 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,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the 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 or she did not build or improve for the purpose of sale.).
U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with -a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , B.& P.C. for this reason
Date
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. My workers' compensation insurance carrier and policy number are:
Carrier Policy Number
1 certify that, in the performance of the 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, and agree that, if I should become subject to the workers' compensation, provisions of Section 3700 of the Labor Code, I shall
` Gfort 'th comply with those provisions.
ate � 7 � Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS IJ ND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for hich this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
APPLICANT
IMPORTANT Application is hereby made to the Director of Buildin and Sa ett fo apermit CKNOWLEDGEo the
s set forth on this
1. Each person upon whose behalf this application is made, each pe son at w se r questa d foorhose benefit work isnditions and nperformed under or puts ant to any permit
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City of La Quinta, its
officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit.
2. Any.permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to cancellation.
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 herreby authorize representatives of this county to enter up the above-mentioned property for inspection purposes.
(�/
/ Datenature (Applicant or Agent):
Page
2
Application
Number .
. .
... -04-00005616 Date
7/23/04
Qty
Unit Charge
Per
Extension
BASE FEE
.0
15.00
3.00
.9.0000
EA
MEQH FURNACE <=100K
27.00
3.00
9.0000
EA'
MECH B,/C <=3HP/100K BTU
27.00
5.00
6.5000._EA,
MECH VENT,_FAN
32.50
1.00
6.50.00
EA
-ME CH EXHAUST HOOD.
6..50
Permit
ELEC-NEW;,RESIDENTIAL
Additional
desc
Permit Fee
. . . .
121.59
Plan Check; Fee
7.60
Issue Date
Valuation +
0
Qty
Unit 'Charge
' Per
Extension
,BASE FEE
15.00
2583.00
.0350
E'LEC 1NEW `RES - 1 OR, 2 'FAMILY
90.41
809.00
.0200
ELEC.-GARAGE OR 'NON-RESIDENTIAL.
16.18
Permit .
. . . . .
PLUMBING_
Additional
desc
Permit Fee
166.50
Plan Check Fee
10.41
Issue Date
Valuation . . .
0
Qty
Unit Charge
Per
Extension
BASE FEE
15.00
16.00
6.0000'
EA
,PLB. FIXTURE
96.00
1.00
15.00-00
EA
PLB'^B:UTLDING SEWER
15.00
1.00
7.5000
EA
PLB WATER'HEATER /VENT
7.50
1.00
3.0000
EA
P.,LB::WATER.INST/ALT/REPS
3.00
1.00
9.0000
EA
'PLB"-LAWN.SPRINKLER SYSTEM
9.00
8.00
.750.0
EA
PLB ,GAS PIPE >=5
6.00
1.00
15.0000
EA "
PLB GAS METER
15.00
------------------
Permit .
---------
. . . . .
----------------------------=--------------------
GRADING PERMIT
Additional
desc
Permit Fee
15..00 Plan Check Fee
.00
Issue Date
. . . .
Valuation
0
Qty -Unit
Charge
Per
Extension
BASE .FEE
15.00
------------------
Special Notes
and'.Comments
SFD - LOT
17, PLAN'1/CASITA. PERMIT DOES.
r
Page
3
Application Number, J
0A-0'0005;616. Date
7/23/04
Special Notes :and
Comments
NOT INCLUDE BLOCK
WALLS, POOL,
;,-.SPA OR.- ..
DRIVEWAY APPROACH.:7,5;%•.'REDUCTION.TO
PLAN
CHECK FEE DUE,TO MULTIPLE ISSUANCE -OF-' '
SAME .PLAN TYPE
Other Fees . . .
... . . . .s
ART IN.PUBLIC PLACE'S -RES
.00
DIF..COMMUNITY CENTERS -RES
97.00
°DI,F • CIVIC .CENTER - RES
366.00
ENERGY 'REVIEW FEE-
14.32
'DI•F FIRE'PROTECTION-RES
97.00
GRADING PLAN'CHECK FEE
.00
DIF LIBRARIES - 'RES
225.00
DIF'PARK,_,MAINT FAC RES
5.00
`D.IF PARKS/REC.- RE'S
502.00
STRONG -MOTION- (SMI) - RES
16.88
DIF STREETMAINT FAC. -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary
Charged-
Paid Credited
Due
Permit Fee Total
1292.09
00 ,00.
1292.09
Plan Check.To.tal
167.92
0.0 00
167.92
Other Fee Total
2436.201
.00 .00
2436.20
Grand Total
3896-.21
.00 :00
3896.21
-.
t