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04-5602 (SFD)i S L TAMPICO ALIFORNIA 92253 BUILDING PERMIT APN: Application description . . . Property Zoning . . . . Application valuation . . . . BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (160) 777-7011 INSPECTION REQUESTS (760) 7.77-7153 0-1-- 0 0 005. 602- Date 7/23/04 57669 SANTA ROSA TR 762-240-013-11 -30487 - DWELLING - SINGLE FAMILY DETACHED LOW DENSITY RESIDENTIAL 2.06412 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 ---------------------------------7------------------------------------------ Permit BUILDING PERMIT Additional desc Permit Fee . . . 1014.00 Plan Check Fee 659.10 Issue Date . . . Valuation . . . . 206412 Qty Unit Charge Per Extension BASE FEE .639.50 107.00 3.5000 THOU BLDG'1'00,001-500,000 374.50 ---------------------------------------------------------------------------- Permit . . . . . . MECHANICAL_ Additional desc Permit Fee . . . . 103.00 Plan Check Fee 25.75 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per BASE FEE Extension 15.00 P.O. Box 1504 78-495 CALLS TAMPICO VOICE (760) 777-7012FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: el- jr6o aJ---;4.rchitezt Date: R— L4 ^OL1 Applicant: or Enaineer: Applicant's Mailing Address: Architect or Engineer's Address: No. <4 b F6 v BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Cha ter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals ode, and my Lice is in full force and effect. cense ClassL�e No.�� Date —C–ontractor OWNER43UILDER 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 1, 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 gontracting 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' 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 perfornance 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 Iffornth 'th complywith those provisions. ate % l Applicant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWF L; 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 Lender's Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Buildingand Safety for ct to the and restitficins set forth on 1. Each person upon whose behalf this application is made, each person atwhos'e request st a d for whose benefit works Performed undersor pulrsuant 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 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. I agree to comply with all city and county ordinances and state laws relating to building construction, a d hyeby a�Sigznature(Applicant hE resentatives of this county to enter upon the above-mentioned property for inspection purposes. Date ��` 7 ent or Agent J Page 2 Application Number, 04-,00005602 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 18.00 7.00 6.50'00 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 35.87 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 41.06 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 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 15.00 Special Notes and Comments SFD - LOT 11 PLAN 3/CASITA. PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL,, SPA OR Page 3 Application Number . . . . 04-00005602 Date - 7/23/04 ----------------------- Special Notes and ------------ Comments -------------------------- -------------- DRIVEWAY APPROACH' ----------------------- Other Fees ----------- . . . --------------------------_--------------- ART IN PUBLIC PLACES -RES 20.00 DIF COMMUNITY CENTERS -RES, 97.00 DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE 65.91' 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 n, 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 .761.78 .0'0 _ .00. 761-.78 Other.Fee Total 2511.55 .00 .00 2511.55 Grand Total 4713.06 .00 .00 4713.06 ?•Mx Certificate of Occupancy r V G�OF'T1'�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: 57-669 SANTA ROSA TRAIL =' Use classification: SINGLE FAMILY DWELLING Building Permit No.: 04-5602. Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL f Owner of Building: SANTA ROSA DEVELOPMENT Address: 40487 SANDPIPER COURT, City, ST, ZIP: PALM DESERT, CA 92260 R By: GARY HARTMAN -_ bZ" l Date: SEPTEMBER 14, 2005 Building Official x - POST IN A CONSPICUOUS PLACE q . w