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04-6763 (SFD)40 0 BUILDING & SAFETY DEPARTMENT C .1 ,� P.O Box 1 �'Oi4 (760).777-7012 F 78-495 CAL i1 TAMPICO FAX) ( 760 777-701 1 p NOV 2.8 1. tTAi C�ALIFORNIA,92253 INSPECTION REQUESTS (760).177-7153 CITY0FLAQUIN1&i BUILDING PERMIT FINANCE DEPT. Application Number X04O=0=Q0=6763,__ Date 10/21/04 Property Address ... . . . L57773__SANTA ROSA TR APN: 762-240-013-7 30487 - Application description . . . DWELLING -,SINGLE FAMILY DETACHED Property Zoning . . . . . . LOW DENSITY RESIDENTIAL Application valuation.. 168030 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 04/30/05 CSLB: 798228 08/31/05 CCC: B ------ Structure Information 2728 SQ. FT. SFD ----- Construction Type TYPE V - NON RATED Occupancy Type . . . . DWELLG/LODGING/LONG <=1d Flood Zone . . . . . . NON -AO FLOOD ZONE, Other struct info . . . . . CODE EDITION 2001.CBC #BEDROOMS 3.00 FIRE SPRINKLERS NO GARAGE SQ FTG 514.00 PATIO SQ FTG 144.00 NUMBER OF UNITS 1.00 FIRST FLOOR SQ FTG 2728.00 ---------------------------------------------------------------------------- Permit . . . . BUILDING PERMIT Additional desc Permit Fee . . . . 881.00' Plan Check Fee 572..65 Issue Date . . . . Valuation 168030 Expiration Date 4/14/05 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 90.00 Plan Check Fee 22.50 Issue. Date . . . . Valuation 0 Expiration Date 4/.14/05- ,Qty /.14/05 ,Qty Unit Charge Per Extension BASE 'FEE 15.00 2.00 9.0000 EA MECH FURNACE <=100K 18.00 P.O. Box 1504 " VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 44 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: a1/- &7(o3 I Date: Applicant: Applicant's Mailing Address: or -Architect or Engineer's Address: CA- 7zzt No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perl'ury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals C de, and my License is in full force and effect. G �/ ense Class 'IT2 icense No. 7 e Yontractor 6< N i 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. , B.8 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 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, I shall forthwith comply with those provisions. /nate / fZ Lplicant r/ IA.,, 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.). 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 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. I 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 and hereby authorize representatives of this county to enter upon the ab -mentioned property for inspection purposes. to ignature (Applicant or Agent . f Page 2 Application Number 04-00006763 Date 10/21/04 Qty Unit Charge. Per Extension 2.00 9.0000 EA MECH B/C <=3HP/100K BTU 18.00 5.00 6.5000 EA MECH VENT FAN 32.50 1.00 6.5000 ------------7------------------------------------------------7-------------- EA. MECH EXHAUST HOOD 6.50 Permit . . . . . . ELEC-NEW RESIDENTIAL Additional desc Permit Fee . . . . 135.76 Plan Check Fee'. 33.94 Issue Date Valuation . . . . 0 Expiration -Date 4/14/05 Qty Unit Charge Per Extension BASE FEE 15.00 2728.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 95.48 `514.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 10.28 1.00 15.0000 ----=----------------------------------------------------------------------- EA ELEC TEMPORARY POWER POLE 15.00 - Permit . . . . . . PLUMBING Additional desc Permit Fee . . . . 179.25 Plan Check Fee 44.81 Issue, Date . . . . Valuation . . 0 Expiration Date 4/14/05 Qty Unit Charge Per Extension BASE FEE 15.00 18.00 6.0000 EA PLB FIXTURE 108.00 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 Expiration Date 4/14/05 Qty Unit Charge Per Extension BASE FEE 15.00 ------------------------------------------------------------------------ Special Notes and Comments 2728 SQ. FT. SFD. THIS PERMIT DOES NOT INCLUDE POOL &.SPA BLOCK WALLS,OR 0 Fee summary Charged Permit Fee Total 1301.01 Plan Check Total 673.90 Other Fee Total 2479.07 Grand Total 4453.98 Paid Credited Due .00 .00 1301.01 .00 .00 673.90 .00 .00 2479.07 .00 .00 4453.98 Page 3 Application Number 04-00006763 Date 10/21/04- ---------------------------------------------------------------------------- Special Notes and Comments DRIVEWAY APPROACH. 10/13./04 1:55:42 PM JJOHNSON ---------------------------------------------------=------------------------ Other Fees . . . . . . . ART IN PUBLIC PLACES -RES .00 DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 ENERGY REVIEW FEE 57.27 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 16.80 DIF STREET MAINT FAC -RES 15.00 DIF TRANSPORTATION - RES 1098.00 Fee summary Charged Permit Fee Total 1301.01 Plan Check Total 673.90 Other Fee Total 2479.07 Grand Total 4453.98 Paid Credited Due .00 .00 1301.01 .00 .00 673.90 .00 .00 2479.07 .00 .00 4453.98 �� r Occupancy, .-Gertifiqate-of F" �wJ"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. 57773 SANTA ROSA TR Use classification- SFD04 Building Permit No..: -6763 Occupancy Group- R3 Type of Construction: VN Land Use Zone- RL Owner of Building- SANTA ROSA DEV LLC Address: 40847 SANDPIPER CT ,City, ST, ZIP. PALM DESERT CA 92260 By- GARY HARTMAN Date: 1-26-06 Building Officia/ POST IN A CONSPICUOUS PLACE