04-5609 (SFD)t
in
BUILDING& SAFETY DEPARTMENT
P.O. Box 1504 (760),777-7012
78-495 CALLE TAMPICo FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS.(760) 777-7153
BUILDING PERMIT
AppiII� a AUG V 4 X004 ---�
tiaation Number . . �0-4�'''0�000�" 5609
Date 7/23/.04
Propertty_-IAddresslNTA•
SANTA
APN:� FINAIdCEDEPT.
57617 R08A TR
762-240-013-13 .-30487 -
Appl•cationdescription
. . . DWELLING - SINGLE FAMILY
DETACHED
Property Zoning . . .
... . . LOW DENSITY RESIDENTIAL
Application valuation
206412
.
t
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/LONG <=10
Flood Zone . . . . .
. . . NON -AO FLOOD ZONE
Other struct info
CODE EDITION
2.001 CBC .
FIRE SPRINKLERS
NO
GARAGE SQ FTG
761.00
PATIO SQ FTG
481.00
NUMBER OF UNITS
1.00
FIRST.FLOOR SQ FTG
3236.00
----------------------------------------------------------------------------
Permit . . . . . .
BUILDING PERMIT
Additional desc
Permit Fee . . . .
1014.00 Plan Check Fee
164.78
Issue Date
Valuation . .
. . 206412
Qty Unit Charge
Per
Extension
BASE -FEE
.639.50
107.00 3.500'0
THOU BLDG 100,001-500,000
374.50
----------------------------------------------------------------------------
Permit . . . . . .
MECHANICAL
Additional desc
Permit Fee . . . .
103.00 Plan Check Fee
6.44
Issue Date
Valuation
0
Qty : Unit Charge Per
BASE FEE
Extension
15.00
i
P.O. BOX 1504
78-495 CALLE TAMPICO VOICE (760) 777-7012FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:— Sip 1� �J Lrrhitpt-f
Date: - Li —O q
Applicant: nr Fnninnor' w
Applicant's Mailing Address:
Architect or Engineer's Address:
Lic. No.:\V � �3 0
t$UILUINC7 PERMIT DECLARATIONS
z L.
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 Lic a is in full force and effect. � 7�
License Class ss icense No.
Date - 4 Contractor CJ�� ��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 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 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 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
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:
Cartier 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'
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 Y -p Applicant
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.).
Lenders 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, indemnity and hold harmless the City of La Ouinta, 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.
1 certify that I have read this application and state that the above information is correct '1 agree to comply with all city and county ordinances and state laws relating to building
ccoonstruccti�oUandhby authorize representatives of this county to enter upo above-mentioned property for inspection purposes.
ate drSig
(Applicant or Agen .
Page
2
Application
Number
04-00005609 Date
7/23/04
Qty.
Unit Charge
Per
Extension
2.00
9.0000
EA MECH FURNACE <=100K
18.00
2.00
9.0000
EA MECH B/C <=3HP/100K BTU
1'8.00
7.00
6.5000
EA MECH VENT FAN
45.50
1.00.
6.5000
EA MECH EXHAUST HOOD
6.50
Permit .
. . . . .
ELEC-NEW RESIDENTIAL
Additional
desc
Permit Fee
143.48 Plan Check Fee
8.97
Issue Date
Valuation
0
Qty
Unit Charge
Per
Extension
BASE FEE
15_.00
3236.00
0350
ELEC NEW RES -'1 OR 2 FAMILY
113.26.
761.00
.0200
ELEC GARAGE OR NON-RESIDENTIAL
15.22
----------------------------------------------------------------------------
Permit ..
. . . . .
PLUMBING
Additional
desc
Permit Fee
. . . .
164.25 Plan Check Fee
10.27
Issue Date
. . . .
Valuation
0
Qty
Unit Charge
Per
Extension
BASE FEE
15.00
17.00
6.0000
EA PLB FIXTURE
102.00
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
9.00
.7500
EA PLB GAS PIPE >=5
6.75
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
15.0'0
Special Notes
and Comments
SFD - LOT
13 PLAN 3/CASITA. PERMIT DOES-,,
NOT INCLUDE
BLOCK WALLS,'POOL, SPA OR
I
Page 3
Application Number
. . . . .
04-00005609
Date
7/23/04
-----------------------------------------------------------------=----------
Special Notes and
Comments
DRIVEWAY APPROACH.75%
REDUCTION
TO
PLAN
CHECK FEE DUE TO MULTIPLE ISSUANCE
OF
SAME PLAN TYPE.
----------------------------------------------------------------------------
Other Fees . . .
. ... . . .
ART
IN PUBLIC PLACES -RES
20.00
DIF
COMMUNITY CENTERS -RES
97.00
DIF
CIVIC CENTER - RES
366.00
ENERGY
REVIEW FEE
. 16.48
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
20.64
DIF.
STREET MAINT FAC -RES
15.00
DIF
TRANSPORTATION - RES
1098.00
Fee summary
-----------------
Charged
Paid Credited
Due
Permit Fee Total
-----=----
1439.73
----------
--------------------
.00 .00
1439.73
Plan Check Total
190.46
.00 .00
190.46
Other Fee -Total
2462.12
.00 .00
2462.12
Grand Total
4092.31
.00 - .00
4092.31
3 Gertiftcate"oOccu ancp Y.
Aht 44Q
OF 1'1 :. : 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
construction and/or use.
BUILDING ADDRESS: 57617 SANTA ROSA TR
Use classification- SFD Building Permit No : 04-5609
Occupancy Group: R3 Type of Construction: VN Land Use Zone- RL
Owner of Building- SANTA ROSA DEV Address- "40847 SANDPIPER CT
} City, ST, ZIP: PALM DESERT CA 92260
By: GARY HARTMAN
-�-� Date: 12-1-2005
uilding Of Ici
POST IN A CONSPICUOUS PLACE
1101
C��
.. • ° of .- � � - � � .. R .
� - ,� s ...�--�•( F FLA QUARTMENT••
_61Ui L -D1' Y
F moo. 77-7012 -
INSPE N REOUEST'LINE, "'-
r�-- 7 7-7153 ..�
Own r - ;ct
Contractor__:_ - INC.
Permit Number 04-5609
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES }
57617.SANTA ROSA TR > 'f
JOB ADDRESS x '
SFD -LOT 13 PLAN 3/CASITA. PERMIT DOES,
NOT INCLUDE BLOCK WALLS, POOL, SPA OR
DRIVEWAY APPROACH/REPLACEMENT JOB CARD
I TYPE OF INSPECTION DATE INSP. `
i
TEMPORARY POWER
j. SETBACKS '
U/G PLUMBING/ WASTE
U/G ELECTRICAL /.GROUNDING
FOOTINGS / STEEL !
CONCRETE SLAB
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED + '
j ROOF NAIL/ PRE -ROOF •�
s OKAY TO WRAP
I FRAMING COMBINATION
I ROUGH ELECTRIC
ROUGH PLUMBING_
ROUGH MECHANICAL
INSULATION 6'
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD. DRYWALL },'• ''
EXTERIOR LATH 5` of A
GAS TEST
SEPTIC ABANDONMENT "
i SEWER CONNECTION,
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS • f
FOOTINGS /STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS I
PRE-GUNITE / SETBACKS
U/G PLUMBING `
U/G GAS I
U/G ELECTRICAL
PRE -PLASTER ALARMS /BARRIERS)
FINAL INSPECTIONS `
TEMP. USE OF PERMANENT POWER
ELECTRICAL
PLUMBING
MECHANICAL j
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT. - O•—OS
FINAL / JOB COMPLETED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TI IRN ON UTILITIES OR OCCUPY BUILDING.