04-3750 (SFD)0
Tdf .4.4 a"
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504
(760).777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPE.CTION_REQ=UESTS7(760) 777-7153
BUILDING PERMIT
Qty Unit.Charge Per
BASE FEE
Extension
15.00
Application Number .
. . . 04-000_0-1- -:Date
4/30/04
Property Address
.. 57747 SANTA ROSA
APN:
762-240-013=8---•=3048`7 -
Application description
. . . DWELLING -'SINGLE FAMILY
DETACHED
Property Zoning . . .
. . .. LOW DENSITY RESIDENTIAL
Application valuation
179157
Owner
Contractor
SANTA ROSA DEV
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: 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
2001CB.0
FIRE SPRINKLERS (
NO
GARAGE SQ FTG
710.00
PATIO SQ ;-FTG
610. OQ,_
NUMBER OF UNITS- -_
1.00`�
FIRST FLOOR SQ FTG �
2747.00 '
Permit . . . . . .
BUILDING PERMIT
Additional desc
Permit Fee . . . .
891.50 Plan .Check Fee
144.87
Issue Date
Valuation . .
. . 171191
Qty Unit'Charge
Per
Extension
BASE FEE
.639.50
72.00 3.5000
---------------------------------------_-----'--------------------------------
THOU BLDG 100,001-500,000
252.00
Permit . . . . . .
MECHANICAL..•, ._ ,.
Additional desc
Permit Fee . . . .
114.50 Plan Check. Fee
7.16
Issue Date . . . .
Valuation . .
. . 0
Qty Unit.Charge Per
BASE FEE
Extension
15.00
1 �
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: 07- a Date:
Applicant ,AfchitV or Engineer:
y f&L,,-a
Applicant's Mailing Address:
Architect or En gInee 's Address:
q4 -+D0 1VLe� ey �iu� Svt 2�1L
�NO.
BUILDING 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 my Lic a is in full force and effect. �� �^ n
cense Class -,cense NLo. (,
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' 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 insu%nnrcarrier and policy number are:
Cartier • "15olicy Number A
ertify that, in the performance of the work for w h th' ertnit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Califo a, an r A f I uld become subject to the workers' compensation provisions of Section 3700 of the labor Code, I shall
forthwith comply with thos provisions.
ate -A-..Ii ��—
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 pena t of perjury that there is a construction nding agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
�Lendefs Name [v- //
ers Address P�� _`31 i6 9 a k/��� f� r �20�3 - /67v
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 abo mfo ati e I agree to comply with all city and county ordinances and state laws relating to building
construc ' n, and hereby authorize representatives of this co my to ent up nth a ve-mentioned property for inspection purposes.
Date ignat/S ure (Applicant or Agent
u
Page
2
Application
Number .
. .
. . 04-00003750 Date
4/30/04
Qty
Unit Charge
Per
Extension
3.00
9.0000
EA
MECH FURNACE <=100K
27.00
3.00
9.0000
EA
MECH B/C <=3HP/100K BTU
27.00
6.00
6.5000
EA
MECH VENT FAN
39.00
11.00,
-------------------------------------------;---------------------------------
6.5000
EA
MECH EXHAUST HOOD
6.50
Permit
. . .
ELEC-NEW
RESIDENTIAL
Additional
desc
Permit Fee
. . . .
125.35
Plan Check Fee
8.77
Issue Date
. . . .
Valuation . . . .
0
Qty
Unit Charge
Per
Extension
BASE FEE
15.00
2747.00
.0350
ELEC NEW RES - 1 OR 2 FAMILY
96.15
710.00
----------------------------------------------------------------------------
.0200
ELEC GARAGE OR NON-RESIDENTIAL
14.20
Permit .
. . .
PLUMBING
Additional
desc
Permit Fee
. . . .
199.50
Plan Check Fee
12.47
Issue Date
. . . .
Valuation . . . .
0
Qty
Unit Charge
Per
Extension
BASE FEE
15.00
20.00
6.0000
EA
PLB FIXTURE
120.00
1.00
15.0000
EA
PLB BUILDING SEWER
15.00
2.00
7.5000
EA
PLB WATER HEATER/VENT
15.00
1.00
3.0000
EA
PLB WATER INST/ALT/REP
3.00
1.00
9.0000
EA
PLB LAWN SPRINKLER SYSTEM
9.00
10.00
..7500
EA
PLB GAS PIPE >=5
7.50
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
8, PLAN 2/CT.PERMIT
DOES NOT
Page 3
Application Number
04-00003750 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
.00
DIF COMMUNITY CENTERS -RES
97.00
DIF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
14.49
DIF FIRE. PROTECTION -RES
97.00
GRADING PLAN CHECK FEE
.00
DIF LIBRARIES - RES
225.00
DIF PARK MAINT FAC - RES
6.00
DIF PARKS/REC - RES
502.00.
STRONG MOTION (SMI) - RES
17.11
DIF STREET MAINT FAC -RES
15.00
DIF.TRANSPORTATION - RES
1098.00
Fee' summary
-----------------
Charged
----------
Paid Credited
Due
Permit-Fee Total
1345.-85
-------------------------------
.00 .00
1345.85
Plan Check Total
173.27
.00 .00
173.27
Other Fee Total
2437.60
�.00 .00
2437.60
Grand Total
3956.72
.00 .00
3956.72
Sent By: AMPAM-LDI; 909 340 9688;
57-747 Santa Rosa Trail
Site Address
May -12-05 8:53; Page 17%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 option!.) 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).
J r
HVAC SYSTEMS:
Xeadag Equipment
Equip. Type
# of
Efficiency
Duct
Duct or
Heating
Heating
(pkg. heat CEC Certified MR, Make di:
Identical
(AFUE,etc.)'
Location
Piping
Load
Capacity
Pump, etc.) Model Number
Systems
[ZCF-1R value]
(attic, etc.)
R value
(Btu/ht)
(BTU/FIr)
FAU CARRIER 59STXI10122
1
80.090
ATTIC
R-4.2
110,000
FAU CARRIER 58STX090116
1
80.090
ATTIC
R-4.2
90,000
Cooling Equipment
Equip. Type
# of
EI%ciency
Duct
Cooling
Cooling
(pkg. heat CEC Certified Compressor Unit
Identical
(SEER, etc)'
Location
Duct
Load
Capacity
pump, etc.) Mfr. Name and Model Number
Systems
[aCF-IR value]
(atttc, etc.)
R -value
(Bwlhr)
(BTU/Hr)A/C
COND. CARRIER 38BRC060000
1
12
ATTIC
R-4.2
60,000
AX COND. CARRIER 3BERC048000
1
12
ATTIC
2-4.2
48,000
12 reads greater than or equal to,
1, 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 1 R) 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 Pari 6), where applicable.
AMPAM LDI Mechanical
izu 5/112005 HVAC Subcontractor (Co. Name)
OR General Contractor OR Owner
WATER HEATING SYSTEMS:
Water CEC Certified Distribution IfRecir- Rated laput Tank 'Efficiency , Standby External
Heater Mfr Name & Type (Sid, culation, # of Identical (kW or Volume (EF, RE) Loss (%) Insulation R -
Type/# Model Number Point -of -Use) Control Type Systems 13tu/hr) (gallons) value
FAUCETS & SHOWER HEADS;
All faucets and showerheads installed are listed in the Commisions Directory of Certified Faucets and Showerheads, ,
pursuant to Title -24, Part 6, Subchapter 2, Section 111.
1, the undersigned, verify that the equipment listed in the catcgmy 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 U
Signature, Date Plumbing Subcontractor (Co. Name)
OR General Contractor OR Owner
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
=:Cerifcto of Occupancy a?dy
4
OFT_ Building & Safety Department
1
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: 57-7.47 SANTA ROSA:-TRAIL
Use classification: SFD - l ' . Building Permit No.: 04-3750
Occupancy Group: R3 Type of Construction: VN " . Land Use Zone: RL-
Owner of Building: GREYHAWK, INCAddress: -1603 TRASK RD
City, ST, ZIP: ENCENITAS,CA92024
r' By: GARY HARTMAN
r
�l b' Date. -30-2005
Building Official
'In
Ll
" POST IN A CONSPICUOUS PLACE