04-5618 (SFD)- BUILDING & SAFETY DEPARTMENT
P.O. 11 ��x=1504 (760):777-7012
10F 1t�`9 7'8-495 `ALLE TAMPICO FAX (760) 777-7011
r�. i� ,:.
Au� 4 iCA Qut•NTA,. CALIFORNIA 92253 INSPECTION REQUESTS'(760) 777-7153
cls of LAQU1%,TA BVILDING PERMIT
FItdAAcE D�P7.
Application :Number'04 00;00.5618 Date 7/23/04
.Property Address .,.,-5-75-5'0'-""S'ANTA .ROSA TR
�APN;:: 7:62-240-0.13=1.9 _34,087.,. -
Application 'descr.iption..: ,;'DWEL.LING�. -S'INGLE FAMILY DETACHED
Property Zoning ,LOW�;DENSITY RESIDENTIAL
Applicat ion�.valuaaion. `168844 ;p
Owner Contractor
SANTA ROSA DEV ^'GREYHAWK, ' INC.
40847.SANDPIPER CT 1.6.03.TRASK ROAD
PALM. DESERT' CA 92260, ENCIN.ITAS CA 92024
r•
WCC: EXEMPT
:.,
a"' �.... WCc EXEMPT 10/21/04.
.0
798228: "08/31/05
CCC ' B
-=-=---- -------- Structure Informati,on,:--- ---------------------
Construction Type TYPE`.V 'NON RATED
Occupancy Type,, DWELLG'/LODGING/LONG <'=10
Flood Zone NQN',A' O -FLOOD ZONE
Other struct info CODE EDITIO14 2.001 CBC .
# ;BEDROOM;S. 4.0.0
F.
FIRESPRINKLERS. NO
GARAGE SQ FTG, .809.00
PATIO SQ --FTG 394.00
.NUMBER". OF UNdTS'° 1.00
`{ : ` FG .00FIR
Permit . . BUILDING PERMIT
Additional des`
Permit -,Fee 8,8.:1.00: Plan Check- Fee 143.16
Issue Date `.. Valuation . . . . 168844
Qty Unit Charge. Per Extension
BAS E'FEE 639.50
69.00 .3:-'5000 'THOU BLDG.. 100,,0-01.-50.0;_000 241.50
Permit , MECHANICAL,
Additional des`
Per'' Fee 10.8 .0,0, Y Plan iCheck,.Fee' . 6.75
Issue Date " Valuation 0
Qty Unit Charge Per Extension
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:
Applicant:
Applicant's Mailing Address:
S
Date: �S ' q--(� �{
chitect or Engineer:
_ 4 cid chc Aoou- -r;4,o sL,
Architect or €ngineer's Address:
ic. No. _S -DS 00
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 Licen sin full force and effect.
,,.,License icense C�ljass 'ss cense No.
Date O ontractor_ C J1 � � % .✓�/ �l�(
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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 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 1, 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. , BA P.C. for this reason
Date Owner
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
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
lGforth 'th comply with those provisions.
Rate r/, fCpplicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVE L, AND 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
1 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
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each. person at whose request and for whose benefit work is 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, indemnify 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 certity 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 upon the above-mentioned property for inspection purposes.
/Date o /' nature (Applicant or Agen
Page 2
Application Number . . . . . 04-00005618 Date 7/23/04
Qty
Unit Charge
Per
Extension
BASE FEE
15.00
3.00
9.0000
EA
MECH 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
6.5000
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'NEW 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
15.0000
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
9.0000
EA
PLB LAWN SPRINKLER SYSTEM
9.00
8.00
.7500
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
19, PLAN 1/CASITA.
PERMIT DOES
Page 3
Application Number
04-0,000.5618 Date
7/23/04
Special Notes and
Comments
NOT INCLUDE BLOCK,:.WALLS,,.
POOL, SPA OR
DRIVEWAY AP'PRbACH ...
"
7 5 %. REDUCT_I:ON 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
DI,F CIVIC CENTER - RES;
366.00
ENERGY REVIEW
14.32
DIF FIRE PROTECTION=RES
97.00
GRADING 'FLAN SCHECK FEE
.00
DIF LIBRARIES - RES
225.00
DIF:PARK"K INT FAC - RES
5.00
DIF-"PARKS/REC - RES
502.00
STRONG MOTION (SMI '7 RES
16.88
DI'F STREET",MAINT FAC`' -,°RE$,
15.00
DIF' TRANS P,O.RTF;T,I ON':- RES
1098.00
Fees summary
d
ChargePaid ' Credited
Due
-,=--
,.�a."ry' Perm.t Fee Total.1292.09
-= ------------------------
1292.09
-p-If Tan Check Total
.00 .00
1'67.92 .00 .0.0
167.92
Other Fee ' Total
2436:20 . 00 . 00
2436.20
=;.
Grand Total
3896.;21 .00 .00
3896.21
4a..; Lr
i ✓t,C� � � .A
J
Contractor GRFVRAWK_ INC
Permit Number 04-5618
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 57-550 SANTA ROSA TRAIT.
SFD — LOT 19, 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 /o- 57
U/G ELECTRICAL/ GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB i
.. DO NOT POUR CONCRETE UN IL ABOVE SIGNED
.'ROOF NAIL /PRE -ROOF /
OKAY -TO WRAP 5s
{ 1
ERA51NG COMBINATION.
:�:�;,�ROUGH ELECTRIC.
UGH PLUMBING
ROUGH MECHANICAL
COVER NO WORK UNTIL -ABOVE SIGNED
TH
SEPTIC ABANDONMENT
SEWER CONNECTION �' o `i S T•
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER
MtGFiANIUAL."l.'
.PUBLICpORKS DEPARTMENT /Z -/j . — , jZ
COMMUNITY DEVELOPMENT DEPT.17 ^- (>
FINAL / JOB COMPLETED /�_ �. /-,--
ABOVE
-,r
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
0� O
CITY OF LA QUINTA _
- w
BUILDING&=SAFETY DEPARTMENT
of
w
INSPECTI,ONIREQUEST LINE
777-7153
�Owner •LSAANTA
ROSA TRAILS, i,I,C
Contractor GRFVRAWK_ INC
Permit Number 04-5618
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 57-550 SANTA ROSA TRAIT.
SFD — LOT 19, 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 /o- 57
U/G ELECTRICAL/ GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB i
.. DO NOT POUR CONCRETE UN IL ABOVE SIGNED
.'ROOF NAIL /PRE -ROOF /
OKAY -TO WRAP 5s
{ 1
ERA51NG COMBINATION.
:�:�;,�ROUGH ELECTRIC.
UGH PLUMBING
ROUGH MECHANICAL
COVER NO WORK UNTIL -ABOVE SIGNED
TH
SEPTIC ABANDONMENT
SEWER CONNECTION �' o `i S T•
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER
MtGFiANIUAL."l.'
.PUBLICpORKS DEPARTMENT /Z -/j . — , jZ
COMMUNITY DEVELOPMENT DEPT.17 ^- (>
FINAL / JOB COMPLETED /�_ �. /-,--
ABOVE
-,r
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
Certificate of Occupancy
T4&t 4 4 Q"
Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building- Coale and the various- ordinances..of the City regulating building
construction and/or use.
BUILDING ADDRESS: 57-550 SANTA ROSA TRAIL
Use classification: SINGLE FAMILY DWELLING
Occupancy Group: R3 Type of Construction: VN
Owner of Building: SANTA ROSA TRAILS, LLC
ZA�
Building Official
Building Permit No.: 04-5618
Land Use Zone: RL
Address: 40847 SANDPIPER CT
City, ST, ZIP: PALM DESERT, CA 92260
By: GARY HARTMAN
Date: DECEMBER 20, 2005
IN A CONSPICUOUS PLACE