04-5619 (SFD)BUILDING & SAFETY DEPARTMENT
P. 0._ 13ox_1.504 (760).777-7012
a-778-4955CALLEMPICo FAX (760) 777-7011
LA QUINTA, CAILIIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
AUG 0 4 2004 . 191 BUILDING PERMIT
CITY OF LA QUINTA
I
FINANCE DEPT.
.�
Application Number .
. . . . 'Date
7/23/04
Property Address. . .
. . . . 57602 SANTA ROSA TR
APN:
762-240-013-21 -30487 -
Application description . . . DWELLING - SINGLE FAMILY
DETACHED
Property Zoning
LOW DENSITY RESIDENTIAL
Application valuation
. . . . 168844
Owner
Contractor
------------------------
SANTA ROSA DEV
-------- -- --------------
GREYHAWK, INC.
40847 SANDPIPER CT
"1603 TRASK ROAD
PALM DESERT
CA 92260 ENCINITAS
CA 92024
(760) 634-1031
WCC: EXEMPT
WC: EXEMPT
.10/21/04
CSLB: 798228
08/31/05
CCC: B
--------------------------
Structure Information -------------
-----------
Construction Type
TYPE V - NON RATED
Occupancy Type
DWELLG/LODGING/CONG <=10
Flood Zone .
. . . NON -AO FLOOD ZONE
Other struct info
CODE EDITION
2.001 CBC
# BEDROOMS
4.00
FIRE SPRINKLERS
NO
GARAGE SQ FTG
809.00
PATIO SQ FTG
394..00
NUMBER OF UNITS
1 ., 0 0
FIRST FLOOR SQ FTG
2583.00
----------------------------------------------------------------------------
Permit . . . . . .
BUILDING PERMIT
Additional desc
Permit Fee
881:00 Plan Check Fee
143.16
Issue Date
Valuation
16.8844
Qty Unit Charge
Per
Extension.
BASE FEE
639.50
69.00 3.5000
--
THOU BLDG 100,001-500,000
--
241.50
-_---
------------------------
Permit . . . . . .
----------------'----------------
MECHANICAL
-----------
Additional desc
Permit Fee . . . .
108.00 Plan Check Fee
6.75
Issue Date
Valuation .
. . 0
Qty Unit Charge
Per
Extension
P.O. BOX 1504 •
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: L 5-47 / 9 I Date: 4 -04
Applicant:
Applicant's Mailing Address:
Engineer.Aeeyo—��c�,C.
or Engineer's Address:
Lic. No.: \ y S-6 u '
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my
License full force and
�icense Class
/� r icense No. 7
Date U Contractor
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. . 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
1 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'
co pensation 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
fo with comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE ISUNDWFUL, 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 3708 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
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 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 certity that I have re d 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,authorize representatives of this county to enter upon the above-mentioned property for inspection purposes.
natur
g e (Applicant or Agent)
Application Number
04-00005619
I
Page 2
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
j
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
J
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 21,
PLAN 1/CASITA.
PERMIT
DOES
Page 3
Application Number
. . . . ..
04-00005619 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
Paid Credited
Due
Permit Fee Total
1292.09
.00 .00
1292.09
Plan Check Total
167.92
.00 .00
167.92
Other Fee Total
2436.20
.00 .00
2436.20
Grand Total
3896.21
- .00 .00
3896.21
/lit
Certificate o Occupancy
y.
_ --ab&
artment
C OF`TI'�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
4
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 57-602 SANTA ROSA TRAIL
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 04-5619
�7
t.
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
R
.
Owner of Building: SANTA ROSA DEVELOPMENT Address: 40487 SANDPIPER COURT
f.
City, ST, ZIP: PALM DESERT, CA 92260
— By: GARY HARTMAN
Date: NOVEMBER 2, 2005
Y
Building Official
POST IN A CONSPICUOUS PLACE
• M
r,