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04-7376 (SFD)F, z< BUILDING & SAFETY, DEPARTMENT C �, P Ox 1r 64/ ` (760).777 ^: 9 78 49,5 -CARL- -TAMPICO F � ', AX (760) 7-77-7011 CALIFORNIA L 92253 INSPECTION REQUESTS (760) 777-7153 Nod` , -' oF'I.�Qu1��a BUILDING PERMIT clrr. ' F1 ANCE DEI' Application Number 04-00007�3s76Date 11/22/04 Property Address :5,7576 SANTA ROSA TR ---1 APN-: 7 6'2-2-4-0,---0-1-3-2-0---3T4- -87 . - Application descript;i'on d :.; `•DWEL'LING.. SINGLE ;;FAMILY DETACHED Property Zoning LOW DENSITY RESIDENTIAL Application valuation-.. 171778 Owner Contractor ------------------------ -_---------------=. SANTA R08A DEV GREYHAWK, INC. 40847 SANDPIPER CT 1603.,TRAS.K'ROAD PALM DESERT CA.92Z60 .. ENCINITAS- CA -92024 (760) 63.4-1031 WCC EXEMPT WC: EXEMPT 04/30/05 0SLB 798228 08/31/05 CCC: B ---'---------------------'--- Structure Information ----------------- ----------- Constructioh.Type TYPE V'- NON. RATED Occupancy -Type DWELLG/LODGING.CONG <=10 Flood Zone . .. . . . . . . NON -AO FLOOD ZONE Other struct info CODE.EDITION 2001 CBC FIrRE - ``$ PR INKL'E.RS NO ...GARAGE. SQ FTG 766.00 PATIO --SQ FTG 13 6 .';0 0 NUMBER. OF ,UNITS. ,w` .. 1.00 FIRST, FLOOR SQFTG 2709-00 ----- ---,------------.--------------------- Permit BUILDING PERMIT Additional'desc Permit!, Fee 89.1.5.0'` Plan _14ck Fee.;' ' 144.87 . Issue DateValuation 171778 Qty Unit Charge Per Extension ,BASE FEE 639.50 72.00 3.50'00 THOU'' BLDG'10`0'; 001-500; 000. 252.00 -- - -- -{-4 - - - - - - - - - - - - - Permit . . . . . MECHANICAL x,Y is Additional desc Permit Fee 90.,0'.0 Plan' -Check -Fee 5.63 Issue Date Valuation 0 Qty Unite Charge;;: Per Extension BASE FEE " 15.00 2.00 9.0,000 ::EA . MECH'.FU'RNACE <=100•K,* , 18.00 2.00 9. 0.000" EA - MECH' B.%C <:=,3HP/1,OOK BTU 1-8.00 5.00 6.5000 --EA MECH VENT'' -FAN 32.50. 1.00 6. 500.0` -.EA-- MECH EXHAUST HOOD 6.50 V 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: Date: ( I. Z Z '6 4 Arcfl1itect or Engin!-!];: �� Q Architect or Engineer's Address: 17 I s-->, /7-cUDn-_ S� J? ic. No.: BUILDING PERMIT DECLARATIONS Gam--eF2-Z"/ / 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 ode, and my Licen a is in full force and effect. License Class --t5cense No. dl IALI 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 I am exempt under Sec. , BA 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' compen ation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is ,• issued. My workers' compensationrance carrier and policy number are: ^4rner 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. /Bate /—&ZZ, opplicant_ 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 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 bf 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 construct�6e�ignature on, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. Date (Applicant or Agent): Page 2 Application Number 04-0000737:6 Date 11/22/04 -----------------------------------------------=---------------------------- Permit . . . . . ELEC-NEW.RESIDENTIAL Additional desc Permit Fee '. 125.14 Plan Check Fee 7.82 Issue Date Valuation 0 Qty Unit Charge Per Extension BASE FEE15.00 2709.00 Y.0350 ELEC NEW_. RES - 1'. OR 2. FAMILY 94.82 766.00:0200` .,ELEC' .GARAGE OR••NON-RESsIDENTIAL _. 15 32 ------------------------=---------------- --=----=-'----'----- -------------------- Permit PLUMBING Additional desc Permit Fee 179.25 Plan Check Fee 11.20 Issue Date Valuation 0 Qty Unit Charge Per., Extension BASE REE 15.00 18.00 6 ..0 0 0 0 EA PLB:'iFI;XTURE" 108.00 1.00 15.'0.000 EA PLB: BUILDING SEWER' i 15.00 1.00 7.5000 EA, PL -B; -'WATER HEATER/VENT 7.50 1.00 1 3.000:0 EA PLB:WATER INST%ALT/REP' 3.00 1.00 9•. 000,0 EA ;PLB LAWN 'SPR_1NKLER SYSTEM 9.00 9.007500. EA PLB ., GAS PIPE > =•5 6.75 1.00 15 ,. 040 0 0 EA PLB_'GAS METER 15.00 Permit . . . . . GRADING,PERMIT Additional desc Permit Fee. 15.0;0 Plan Check Fee .00. Issue Date Valuation 0 Qty Unit Charge Per Extension BAS EF..:EE 15.00 Special.Notes and I Comments SFD - LOT 20.; :2.7'09 ,SFt: .PERMIT DOES`':NOT .INCLUDE POOL, SPA,.BLOCKWALLS; OR'` DRIVEWAY APPROACH,. T518 -REDUCTION TO PLAN' CHECK FEE DUE. TO"'MULTIPLE ISSUANCE OF SAME PLAN. TYPE. t Other Fees . . . ART IN-P;U;L'IC PLACES -RES .00 - .DIF`COMMUNITY CENTERS -RES 97.00 'D.I'F CIVIC CENTER - RES 366.00 ENERGY REU,TEW' .FEE .14.49. DIF; FIRE PROTECTION. -RES 97.00 Page 3 Application Number 04"-00007376: Date 11/22/04 Other Fees .GRADI'NG;PLAN. CHECK -FEE :00 DIF LI=BRARIES - RES' 225.00 DIF PARK MAINTFAC '= RES 5.00 DIFF PARKS:/R.EC - RES-. 502:00 STRONG MOTION ('SM`I.) - RES' 17.17 `D.IF., STREET; MAINT. FAC -RES 15.00 DIF TRANSPORTATION. �'- RES 1098.00 Fee summary'. Charged Paid :;;: Credilted Due Permit `Fee Total-. 13,00-.89•' =00,.. 00 1300.89 Plan Check 'Total <:• 169: 52 : " :.0:0` .00 169.52 Other Fee Total 24.3'6.66 0, Or :.00 2436.66 Grand Total 3907:.07 0%0 '. 00 3907.07 �-a- ��- Certificate of Occupancy i da 13 OF 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 Code and the various ordinances of the City regulating building A construction and/or use. BUILDING ADDRESS: 57-576 SANTA ROSA TRAIL Use classification: SINGLE. FAMILY DWELLING Building Permit No.: 04-7376 Occupancy Group: R3. Type of Construction: VN Land Use Zone: RL Owner of Building: SANTA ROSA TRAILS, LLC Address: 40847 SANDPIPER CT City, ST, ZIP: PALM DESERT, CA 92260 By: GARY HARTMAN Date: DECEMBER 16, 2005 Building Official POST IN A CONSPICUOUS PLACE