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04-5614 (SFD)F BUILDING •& SAFETY DEPARTMENT R O: Bo:,x 1'504 (760).777-7012 -T8=4 V0 9 CALLE TAMPICO FAX (760) 777-7011 ,V0_Ln Q*UIN A,, CALi�FORNIA 92253 INSPECTION REQUESTS (760) 777-7153 4 200 lJ B UILDING PERMIT • OF IJa 0U11 CITY pplit�asi�onE�Number Date 7/23/04 roperty Address _57565, SANTA ROSA TR APN: 762-24'0=0,13, 15 -304:87 - Application description ,DWELLING'. SINGLE,�FAMILY DETACHED Property Zoning. .,,LOW,DENSITY RESIDENTIAL Application ;valuation 164844. Owner Contractor SANTA ROSA DEV" GkEYHAWK, INC. 40847 SANDPIPER GT.. 003. TRA -SK. ROAD PALM DESERT CA 922-60,., • ENCIN.ITA& CA 92024 (76'0) .:6314=1031 . "WCc:EXEMPT WC: EXEMPT 10/21/04 CSLB: 7'98'22'8' 08/31/05 CCC: B" -------------------- =-=-- Structure -Information -`----------------------- Construction Type ... TYPE V ..- NON Occupancy Type •RATED, DWELLG/LODGING'%GONG <=10 Flood Zone . .. . . . . . . NON -AO FLOOD., -,ZONE Other struct info CO.DE.EDITION 2001 CBC . #'BEDROOMS`" 4.00 1 E,IRE­ : SPR'INKLERS NO aGARAGE SQ FTG 809.00 PATIO. SQ .FTG • 394.00 NUMBER OF«UNITS 1.,00 FIRST'.FLOOR SQ; FTG, 2583.00 Permit. . . . ------------------------------ BUILDING,' PERMIT - Additional dese .Permit Fee. 8.8.1. 00 :,... Plan .Check, Fee 572.65 Issue Date Val''uatori 16.8844 Qty Unit Charge Per F-" Extension BASE FEE' 639.50 69.00 3:5000 THOU BLDG 100,00.1-500.,000 241.50 Permit .. . . MECHANICAL: Additional , d_esc Permit Fee ,; „ 5. 1.0;8 00 Plan Check' Fee 27:00 Issue Date Valiat •ion 0 - Qty Unit Charge .. .. . Per a Extension , P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Q - .S10 / Date: OR—(� Applicant: Architor nginee cr: uls �%Sou� ic_ Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.: tSUILUINU 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 Licep is in full force and effect. �lcense Class ---License No.—�-/��l i I-- It/(— OWNER-BUILDER t/L 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 fora 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 c6ntracting 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 contractors) 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 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: Cartier 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 Q �Cpplicant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, 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 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 Lenders Address IMPORTANT Application is hereby made to the Director of BuildingAPPLICANT ACKNOWLEDGEMENT Safety o Ato the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at permit ehose request and for whose benefit works 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 employeesfor 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, land ereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. to �` T Signature (Applicant or Agen . Page 2 Application Number '04=700.005614' Date 7/23/04 Qty. Unit Charge Per. Extension BASE FEE. 15.00 3.00 9.0000.,EA' MECH.FURNACE <=10'OK 27.00 3: 00 9:0000 EA MECH B/'C < 3HP/1;OOK' BTU 27.00 5.00 6. 5 0 0 0 'EA MECH•: VENT FAN 32.50 1.00 6.5000 EA ME CH, EXHAUST -HOOD 6.50 Permit . . . . ELEC-KNEW RESIDENTIAL Additional desc ' Permit Fee. . . . . 121..,59 Plan Check`Fee 30.40 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 EL-'EC..GARAGE ORNON-.-RESIDENTIAL 16.18 ----------------------- Permit . . . . . PLUMBING' Additional desc Permit Fe,e 166::50 Plan Check Fee 41.63 Issue Date . . . . Valuation 0 Qty Unit -'Charge Per Extension BASE FEE. 15.00 16.00 6.°O.000 EA;, PLB FIXTURE 96.00 1.00 15.0000 EA PLB)BUILDING SEWER 15.00 1.00 7.5000 EA PL:B WATER HEATER/VENT 7.50 1.00 3.0,000 -EA PLB-°WATER INST/ALT,/REP. 3.00 1 . 00 ' 9-: 0000 EA P -LB LAWN, SPRINKLER .SYSTEM 9.00 8.00 .7500 EA. P.LB• GAS' PIPE >=5 6.00 1.00 15.0000 EA RLB GAS METER 15.00 --------------- Permit --------------------a------------------,'----------- GRADING':PERMIT ----------- Additional desc' Permit Fee 15..001. Plan Check Fee .00 Issue Date Valuation 0 Qty Unit Charge- Per Extension % BASE FEE 15.00 --------------------------------------------------- ------------------------ :Special Notes and.Comments SFD - LOT 15, PLAN•1/CASITA. PERMIT DOES Page 3 Application Number . . . . . 04-00005614 Date 7/23/04 ---------------------------------------=------------------------------------ Special Notes and Comments NOT INCLUDE BLOCK WALLS, POOL, SPA OR DRIVEWAY APPROACH ------------------------------------7--------------------------------------- Other Fees . ... . . . . . . ART IN PUBLIC PLACES -RES .00 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE 57.27 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 Paid Credited Due Permit Fee Total ---------- 1292.09 ---------- ---- ----- ---------- .00 .00 1292.09 Plan Check Total 671.68 .00 .00 671.68 Other, Fee Total 2479.15 •..00. .00 2479.15 Grand Total 4442.92 .00 .00 4442.92 Certificate of Occupancy T-emf 4 4 QU&M - Buildings & 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 . B.uilding Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 57-565 SANTA ROSA TRAIL Use classification: SINGLE FAMILY DWELLING Occupancy Group: R3 Type of Construction: VN Owner of Building: SANTA ROSA TRAILS, LLC Building Official Building Permit No.: 04-51514 Land Use Zone: RL Address: 40847 SANDPIPER CT City, ST, 'ZIP: PALM DESERT, CA 92260 By: GARY HARTMAN Date: DECEMBER 20, 2005 A CONSPICUOUS PLACE 0 `� �_.CLITY C 13��J.�I�' CI�Pf—SP C1 F Owner NTA ROSA DEV QUINTA DEPARTMENT `777-7012 ON REQUEST LINE 777-7153 Contractor GREYHAWK, INC. Permit Number 04-5614 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 57565 SANTA ROSA TR SFD - LOT 15, PLAN 1/CASITA. PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL, SPA OR DRIVEWAY APPROACH/REPLACEMENT JOB CARD TYPE OF INSPECTION I DATE I INSP. TEMPORARY POWER U/G PLUMBING / WASTE U/G ELECTRICAL/ GROUNDING FOOTINGS / STEEL CONCRETE SLAB DO NOT POUR CONCRETE UNTIL ABOVE SIGNED ROOF NAIL / PRE -ROOF C7 OKAY TO WRAP FRAMING COMBINATION ROUGH ELECTRIC i ROUGH PLUMBING ROUGH MECHANICAL INSULATION COVER NO WORK UNTIL ABOVJFE SIGNED INTERIOR GYP. BD. DRYWALL EXTERIORIATH f l GAS TEST 2 - SEPTIC SEPTIC ABANDONMENT SEWER CONNECTION D SEPTIC/ GREASE INTERCEPTOR MASONRY INSPECTIONS FOOTINGS / STEEL 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 ELECTRICAL PLUMBING MECHANICAL PUBLIC WORKS DEPARTMENT Zd— COMMUNITY DEVELOPMENT DEPT. I Z FINAL / JOB COMPLETED Ln c- ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING