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04-3760 (SFD)f I] P.O: Box -1504 78-495 CALLS TAMPICO LA Q.UINTA, CALIFORNIA 92253 BUILDING PERMIT Application Number Property Address . . . APN: Application description Property Zoning . . Application valuation . BUILDING & SAFETY DEPARTMENT (760) .777-7012 EA -X-(7=60) 777-7011 INS: PECTION,REQUESTS (Z6'0) 777-7153 - .� s., F t 6 r1 3 tie 3T76.0=�-;Q Liu; Datel, 4/29/04 57825 SANTA ROSA TR 762-240-013-6 -30487 - DWELLING - SINGLE FAMILY DETACHED . . . LOW DENSITY RESIDENTIAL 208860 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:' 798.228 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 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'., Additional desc Permit Fee . . . . 118.00 Plan Check Fee 7.38 Issue Date . . . . Valuation 0 :9 j, Qty Unit Charge Per BASE FEE Extension 15.00 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: Q 7(PC Date: S•3 Applicant:ch}',tg;t or Engineer: Applicant's Mailing Address: -ATchitect'or Engineers Ay1dress: ail1 _ (OL I .�•, ��(�`� � G X122 6 a Lic. 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 nd my Lic r is in full force and effect. 7 g Z Z License Class �7 'License No. Date 4-�,3 n cior aPXY vs_ 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 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 ag t if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those pfoVtsi 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 Namep Q ��r o� us.IA4y byj=6 � L �€nder'sAddressf—y &x/3141 (���5 �40% op 8I a— t 6C z C.)/ 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 a 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 u su Qt to auinta, 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 ' rrect. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize rep res ntatives of this co y to up a above-mentioned property for inspection purposes. ate Signature (Applicant or Age 4 Page ", 2 Application Number 04-00003760 Date 4/29/04 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 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 1.0.0 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 --------------7------------------------------------------------------------- Special Notes -and Comments SFD - LOT 6, PLAN 3/CT. PERMIT DOES NOT. Page 3 Application Number . . . 04=00003760 Date 4/29/04 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 193.0"9 .00 .00 193.09 Other Fee Total 2369.62 .00 .00 2369.62 Grand Total 4033.44 .00 .00 4033.44 w Sent By: AMPAM-LDI; 57-825 Santa Rosa Trail 909 340 9688; May -12-05 8:52; Page 16/19 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 infotrnation 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: H of Effeciency Duct Cooling Cooling (pkg. heat CEC Certified Compressor Unit Identical (SEER, etc)' Heating Equipment Load Capacity pump, etc.) Mfr. Name and Model Number S [kCF I R value] (attic, etc.) R -value (Btttlhr) (BTU/Fir) Equip. Type Hof Efficiency Duct Duct or Heating Heating (pkg. heat CEC Certified Mfr, Make & identical (AFUE,etc.)' Location Piping Load Capacity pump, etc.) Model Number Systems [,,CF-iR value] (attic,� R -value (Btu/hr) ( BTU/HL FAU CARRIER 58STX110122 2 80.0% ATTIC R-4.2 110,000 Cooling Equipment Equip. Type H of Effeciency Duct Cooling Cooling (pkg. heat CEC Certified Compressor Unit Identical (SEER, etc)' Location Duct Load Capacity pump, etc.) Mfr. Name and Model Number S [kCF I R value] (attic, etc.) R -value (Btttlhr) (BTU/Fir) A/C COND. CARRIER 38BRC060000 2 12 ATTIC R-4.2 60,000 1 2 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 -1R) submitted for compliance with the Energy Efficiency Standards for residential buildings, and (3) equipment that meets or exceeds the appropriate requirements for manufactured devises (from the Appliance Efficiency Regulations or Part 6), where applicable. AMPAM LD1 Mechanical Je 3/11/2005 HVAC Subcontractor (Co. Name) OR General Contractor OR Owner WATER HEATING SYSTEMS: Water CEC Certified Distribution if Recir- Rated Input Tank Efficiency Standby External Heater Mfr Name & Type (Std, culation, 0 of Identical (kW or Volume (EF, RE) Loss (%) Insulation R- Type/H Model Number Point -of -Use) Control Type Systems Btu/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 I11. 1, 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 then the equipment specified on the Certificate of Compliance submitted to demonstrate compliance with the Energy Efficiency Standards for residential buildings. Signature, Date COPY TO: Building Department HERS Provider (if applicable) Building Owner at Occupancy RCR COMPANIES Plumbing Subcontractor (Co. Name) OR General Contractor OR Owner 'Certificaof Occupancyte G�oF�ti Building & Safety Department f p 1 r a r This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at 1he time of issuance, this structure was in compliance with the City building V provisions of the Building Code and the various ordinances of .,the regulating. E' i : construction and/or use. F BUILDING ADDRESS: 57-825 SANTA ROSA TRAIL F Use classification: SINGLE FAMILY DWELLLING' Building Permit No.: 04-3760 V, Occupancy Group: R3 Type of Construction: V -N Land Use Zone: RL — t Owner of Building: SANTA ROSA DEVELOPMENT Address: 40847 SANDPIPER COURT - F E City, ST, ZIP: PALM DESERT, CA 92260 By: GARY HARTMAN 7 Date: April 26, 2005 Building Official } f POST IN A CONSPICUOUS PLACE µ . ""YK+.c.' ` a Y .uP4F.try