04-5617 (SFD)BUILDING & SAFETY DEPARTMENT
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(760) 777-7012
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" 78-4}95 CA•L� TAMPtCo FAX (760) 777-7011
LA .QUINT' C� ALIFORN[A
92253 INSPECTION REQUESTS (760) 777-7153
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BUILDING: PERMIT
d <
CITY OF LA QUINT%
FINANCE DEPT
App kation Number"
`
;.0'4""0,0005617> Date
7/23/04
Property ,Address
iJ 5 7 5'2 4`'SANTA 'R'OSA ' T:R '
APN:
76.2,-24-0::-.0,13-18. -34087 -
Application description
. DWELLING<:-- SINGLE FAMILY
DETACHED
Property Zoning
.LOW::-DENSTTY RESIDENTIAL -
Application valuation
"°fi688441"1.
Owner
Contractor,,-
SANTA ROSA DEV
GREYHAWK, INC:.
40847 SANDPIPER CT
1-603.;;TRASK ROAD
PALM DESERT CA 9.226.0 ENCIrN_ITAS
CA 92024`
.
, � 0 °.
(,-. )� .,r634-,1;03=1
WCC ..EXEMPT
^a
WC:., EXEMPT
10/21/04
CS'LB: 79'8228
08/31/05
CCC-
--------------------------
-----------
-------------
Structure Information - --------------------------
Construction Type . .
. . . TYPE V - NON'.RATED
Occupancy Type.--.
-DWELLG/LOD`GING/CQNG <=10
Flood Zone
NQN=F,O FLOOD. ZONE
Other struct info
". " CODE''EDITION -`'
2001 CBC
# :'BEDROOMS'.
4.00
FIRE SPRINKLERS
NO
GARAGE SQ FTG.
809.00
PPTIOx:SQ ,,FTG .:
394.00
NUMBER. OF UNITS
1.00
FIRST FtO, R, SQ FTG
2.583.00
Permit . . . . . .. BUILDING PERMIT
Additional desc
Permit Fee.....
881,90 Plan. -.:Check Fee;
143.16
Issue Date
Valzation . .
. 168844
Qty Unit Charge
Pe'.r
Extension
"
c
BASE' FEE
639.50
69.00 3 .5000
THOU BLDG --10,0,.001-500,000
241.50
Permit . . . . . . MECHANICAL`°
Additional desc
Permit Fee,
108:-00 Plan Check wFee
6.75
Issue Date
Val`u'ation
0
Qty Unit Charge
.Per
Extension
' a
P.O. BOX 1504
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 164 -
Applicant: 4 -Applicant:
Applicant's Mailing Address:
Date: Li _V �(
or ngineer:
OLS Aa dv
Architect or Engineer's Address:
No. J-V,-e`bj
BUILDING PERMIT DECLARATIONS
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 my Lice;k in full force and effect. //
License Cle
ass nse No.zg6z,ZS
DateZIA.-Iractor�� /✓(�
OWNER -BUILDER DECLARATION
I 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 civil penalty of not more than five hundred dollars ($500).):
U 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,
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 1 am exempt under Sec. , B.& P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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
I 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
forthwith comply with those provisions.
Date 9A- k:I'�Applicant
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNM UL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
IMPORTANT Application is hereby made to the Director of BuildingAPPLICANT
ACKNOWLEDGEMENT
Safety a
s set forth on this applicauon.
1. Each person upon whose behalf this application is made, each person at Permit
ehose request st and efor conditions sn
whose benefit work performed under or pursuant 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 Ouinta, 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 hereby authorize representatives of this county to enter the above-mentioned property for inspection purposes.
/Date O Sure (Applicant or Agent):
Page
2
Application Number
.
. . . 04"-00005617" Date
7/23/04
Qty Unit
Charge
Per
Extension
BASE FEE,
15.00
3.00
9_0000
:EA. MECH FURNACE :<=1Os0K
- 27.00
3.00
9.000.0
EA MECH B/C:.<=3HP/100K BTU
27.00
5".00
6.5000
EA MECH VENT FAN
32.50
1.00
6.5000
EA MECH 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
ELEC'NEWxRES - 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
6.000'0
EA 'PLB"'FIXTURE'
96.00
1.00
15":`0'000'.
EA PLB BUILDING SEWER
15.00
1.00
7.5000
EA PLB WATER HEATER/VENT
7..50
1.00
3.0000
EA PLB WATER INST/ALT/REP
3.00
1.00
9.00.00
EA`PLB LAWN SPRINKLER.SYSTEM
9.00
8.00
.7500
EA PLB-GAS PIPE.>=5'
6.00
1.00
15:.0000
EA PLB. GA'S' `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 18,
PLAN 1/CASITA.
PERMIT DOES
16
Fee summary Charged
Permit Fee Total 1292.09
Plan Check Total 167.92
Other Fee Total 2436.20
Grand Total 3896.21
Paid Credited
.00
Page
3
Application Number
. . . . . 04=00005617 Date
7/23/04
-------------------------------------------------------_---------------------
Special Notes and
Comments
NOT INCLUDE BLOCK
WALLS, POOL, SPA OR
DRIVEWAY APPROACH.
75% REDUCTION TO PLAN
CHECK FEE DUE TO MULTIPLE ISSUANCE OF
SAME PLAN TYPE
----------------------------------------------------------------------------
Other Fees . . .
. . . . . . ART IN PUBLIC PLACES -RES
.00
DIF COMMUNITY CENTERS -RES
97.00
DIF CIVIC CENTER - RES
•366.00
ENERGY REVIEW FEE
14.32
DIF FIRE PROTECTION -RES
97.00
GRADING PLAN CHECK FEE
00
DIF LIBRARIES - RES
`225.00
DIF PARK MAINT FAC - RES
5.00
DIF PARKS/REC - RES
502.00
STRONG MOTION (SMI) - RES
16.88
DIF STREET'MAINT FAC -RES
15.00
DIF TRANSPORTATION -.RES
1098.00
Fee summary Charged
Permit Fee Total 1292.09
Plan Check Total 167.92
Other Fee Total 2436.20
Grand Total 3896.21
Paid Credited
.00
.00
.00
.00
.00
.00
.00
.00
Due
1292.09
167.92
2436.20
3896.21
CITY OF LA Q�UINTA
BU.ILDyING: & SAFE IN DEPARTMENT
OF
INSPECTION REQUEST LINE
777-7153
Owner SANTA ROSA TRAILS, LLC
Contractor GRFXHAWK, INC,
Permit Number 04-5617
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 57-524 ,SANTA ROSA TRAIT.
SFD — LOT 18, PLAN 1C. PERMIT DOES NOT
INCLUDE BLOCK WALLS, POOL, SPA OR
DRIVEWAY APPROACH
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
SETBACKS
U/G PLUMBING / WASTE m
U/G ELECTRICAL/ GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE UN IL ABOVE SIGNED
ROOF NAIL/ PRE -ROOF I f /9 /a r- 1 Z6 -
OKAY TO WRAP os-
FRAMING COMBINATION
ROUGH ELECTRIC
;ROUGH PLUMBING f it
ROUGH MECHANICAL
INSULATION
COVER NO WORK UNTIL AP OV SIGNED
INTERIOR GYP. BD. DRYWALL 6/
EXTERIOR LATH
GAS. TEST �- L
SEPTIC ABANDONMENT
SEWER CONNECTION 7
SEPTIC./ GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G ELECTRICAL
'PRE -PLASTER (ALARMS/ BARRIERS) I .
.: FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT 2.
COMMUNITY DEVELOPMENT DEPT. .Z -16 - U
FINAL / JOB COMPLETED i;V7
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
•E
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W% a.•C'
Certificate of Occupancy
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Safety Department
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This Certificate is issued pursuant to the requirements of Section 109 of the California Building
9Ji
'
Code, certifying that, at the time of issuance, this structure was in compliance with the
r provisions of the Building Code and the various ordinances of the City regulating building
!
i•,I
�I
J
construction and/or use.
BUILDING ADDRESS: 57-524 SANTA ROSA TRAIL
I7
i
oyt
?
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 04-5617
rte!
f7
'
# Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
r
�
Owner of Building: SANTA ROSA TRAILS, LLC Address: 40847 SANDPIPER CT
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City, ST, ZIP: PALM DESERT, CA 92260
3 ;
By: GARY HARTMAN
8
�;
� Date: DECEMBER 22, 2005
Y
V �
Building Official
{
POST IN A CONSPICUOUS PLACE
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