04-3764 (SFD)BUILDING & SAFETY DEPARTMENT.
P.O. BOX 1504 (760).777-7012
78-495 CALLE TAMPICO-- - --FAX=:08760) 777-7011
�._�.... t �' dP
LA QUIN,TA, CALIF.ORN,IA 92253 INSPECTION R-QUES-TsS ( 60) -777-7153
BASE FEE 15.00
BUILDING PERMIT E, �`si .0
Application, Number
Date ru. Date
4/30/04
Property Address . .
. . . . 57721 SANTA ROSA TR
RM
APN:
762-240-013-9 -30487 -
Application description
. . . DWELLING - SINGLE FAMILY DETACHED
Property Zoning . : .
. . . . LOW DENSITY RESIDENTIAL
Application valuation
.. 208860
Owner
Contractor
------------------------
SANTA ROSA DEV
----•---- - --------4---
GREYHAWK, INC.
40847 SANDPIPER CT
1603 TRASK ROAD
PALM DESERT
CA 92260 ENCINITAS,
CA 92024
(760) 634-1031
WCC: NONE
WC: EXEMPT
08/31/05
CSLB: 798.228
08/31/05
CCC: B
--------------------------
Structure Information --L ------------------------
Construction Type . .
. . . TYPE V - NON RATED
Occupancy Type ..
. . . DWELLG/LODGING/CONG <=10
Flood Zone . . .
. . . NON -AO FLOOD.ZONE
Other struct info . .
. . CODE EDITION 2001
CBC
FIRE SPRINKLERS NO
GARAGE SQ FTG
761.00.
PATIO SQ FTG
'665.00
NUMBER OF UNITS
1.00
------------------------------------------------.----------------------------
FIRST FLOOR SQ FTG
3236.00
Permit . . . .
BUILDING PERMIT
Additional desc
Permit Fee
1021.00 Plan•Check Fee
165.91 "
Issue Date
Valuation . . . .
208860
Qty Unit Charge.
Per
Extension
BASE FEE
639.50
109.00 3.5000
------------------------------------=---------=----------------------------'-
THOU BLDG 100,001-500,,000.
381.50
Permit . . . . .
MECHANICAL, > "f • .
Additional desc
Permit Fee . . . .
118.00 Plan Check Fee
7.38
Issue Date . .
Valuation . . . .
0
Qty Unit Charge
Per
Extension
BASE FEE 15.00
P.O. BOX 1504 • VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-701 l
LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Qq' d 604f Date:
Applicant: Ar 4 ect or Engines
w.fes' c
Applicant's Mailing Address: Architect Qr ngineg's Address.
. o �.�
13UILDING 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 Lice e s in full force and effect. n
�icense class se No. `h
�9ate tkontractor 'el-,( \e --
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 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 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
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, 1 shall
forthwith comply with those rovision .
1
Date Appli
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 for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
enders Name nd?q//
ers Address O 1 O
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 Duinta, 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.
I certify that I have read this application and state that the abov . o ation is I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby =Signature
atives of this co ty to ant t bove-mentione I property for inspection purposes.
,.-'Dat icant or Agen
1
'
Page
2
Application
Number
04-00003764
Date
4/30/04
Qty
Unit Charge
Per
Extension
2.00
9.0000
EA
MECH
FURNACE <=100K
18.00
2.00
16.5000
EA
MECH
B/C >3-15HP/>100K-500KBTU
33.00
7.00
6.5000
EA
MECH
VENT FAN
45.50
1.00
--------------------------------------------------------------
6.5000
EA
MECH
EXHAUST HOOD
6.50
Permit ...
. . . .
ELEC-NEW RESIDENTIAL
7
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
173.25
Plan Check Fee
10.83
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
1.00
9.0000
EA.
PLB
LAWN SPRINKLER SYSTEM
9.00
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
9, PLAN 3/CT.. PERMIT
DOES NOT
Page 3
Application Number
04-00003764 Date
- 4/30/04
-----------------------------------------------------------------------------
Special Notes and
Comments
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
22.15
DIF CIVIC CENTER - RES
367.00
ENERGY REVIEW FEE
16.59
DIF FIRE PROTECTION -RES
98.00
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
20.88
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary
-----------------
Charged
Paid 'Credited
Due
Permit Fee Total
----------
1470.73
-----------------------------,-
.00 .00
1470.73
Plan Check Total
193.09
.00 .00
193.09
Other Fee Total
2369.62
.00 .00
2369.62
Grand Total
4033.44
.00 .00
4033.44.
Sent By: AMPAM-LDI;
57-721 Santa Rosa Trail
Site Address
909 340 9688; May -12-05 8:53; Page 18/19
An installation certificate is required to be posted at the building site or made available for all appropriate inspections. (The information provided on this form
is required, however, use of this form to provide the information is optionl.) After completion of final inspection, a copy must be provided to the building
department (upon request) and the building owner at occupancy, per section 10-103(b).
HVAC SYSTEMS:
# of
Effeciency
Duct
Cooling Cooling
(pkg. heat CEC Certified Compressor Unit
Hearing Equipment
(SEER, etc)'
Location Duct .
Load Capacity
pump, etc.) WE Name and Model Number
Systems
Equip. Type
# of
Efficiency
Duct
Duct or
Heating Heating
(pkg. beat CEC Certified Mfr, Make &
Identical
(AFUE,etc.)'
Location
Piping
Load Capacity
pump, etc.) Model Number
Systems
[2CF-1R value)
(attic, etc.)
R -value
(Btu/hr) (BTU/W)
FAU CARRIER 58STX110122
2
80.0%
ATTIC
R4.2
110,000
Cooling Equipment
Equip. Type
# of
Effeciency
Duct
Cooling Cooling
(pkg. heat CEC Certified Compressor Unit
Identical
(SEER, etc)'
Location Duct .
Load Capacity
pump, etc.) WE Name and Model Number
Systems
[>—CF -1R value]
(attic, etc.) R -value
(Btu/hr) (BTU/W)
A/C COND. CARRIER 38BRC060000
2
12
ATTIC R-4.2
60,000
12 reads greater than or equal to.
L the undersigned, verify that the equipment listed above is: 1) is the actual equipment installed, (2) equivalent to or more efficient than that specified in the
certificate of compliance (Form CF -IR) submitted for compliance with the Energy Efficiency Standards for residential buildings, and (3) equipment that meets
or exceeds the appropriate requirements for manufactured devices (from the Appliance Efficiency Regulations or Part 6), where applicable.
AMPAM LDI Mechanical
Jenm er A tzu 5/11/2005 HVAC Subcontractor (Co. Name)
OR General Contractor OR Owner
WATER HEATING SYSTEMS:
Water CEC Certified Distribution If Rech Rated Input Tank Efficiency Standby External
Heater Mfr Name & Type (Std, culation, # of Identical - (kW or Volume (EF, RE) Loss M Insulation R-
Type/# Model Number Point -of -Use) Control Type Systems BtuLhr) (gallons) value
FAUCETS & SHOWER HEADS:
All faucets and showerheads installed are listed in the Commisions Directory of Certified Faucets and Shower6eads,
pursuant to Title -24, Part 6, Subchapter 2, Section 111.
I, the undersigned, verify that the equipment listed in the category above my signature is the actual equipment installed and that the equipment meets or exceeds
the requirements of the Appliance Efficiency Standards. In addition, I have verified that the equipment is equivalent to or more efficient than the equipment
specified on the Certificate of Compliance submitted to demonstrate compliance with the Energy Efficiency Standards for residential buildings.
RCR COMPANIES
Signature, Date Plumbing Subcontractor (Co. Name)
OR General Contractor OR Owner
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
N
Certiricate of, Occupancy
/^
r
5w
r
OF Building Y & Safety Department
;
4
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
f
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.5-7
`49
r
BUILDING ADDRESS: 57-721 SANTA ROSA TRAIL
P; A
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 04-3764
v
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RL
r
6 tlt
GREYHAWK INC Address: 1603 Trask Road
City, ST, ZIP: Encinitas, CA 92024
s „
By: KIRK KIRKLAND
i
Date: JULY 29, 2005
r 4
Building Official
POST IN CONSPICUOUS PLACE