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