04-3790 (SFD)A
•BUILDING & SAFETY. DEPARTMENT
P.O.'Box 1504 (760).777-7012
0 _ 9 7R-49 LLE TAMPICO FAX (760) 777-7011
D e QL'A U A_CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
MAY 0 3 2004 `: BUILDING PERMIT
CMV ®r l.Gi QIi31e1'fle.
ApplEicat;l�n'�I�Lumb ('04=0"0003_7_90 Date 4/29/04
roper Address .. . . 57862 SANTA ROSA TR
APN: 762-240-013-30 -30487 -
Application description . . . DWELLING - SINGLE FAMILY DETACHED
Property Zoning . . . . . . LOW.DENSITY RESIDENTIAL
Application valuation . . 170892
Owner Contractor
------------------------
SANTA ROSA.DEV• GREYHAWK, INC.
40847 SANDPIPER CT 1603 TRASK ROAD
PALM DESERT CA 92260 ENCINITAS CA 9'2024
(760) 634-1031
WCC NONE
WC: EXEMPT 08/31/05
CSLB: 798228 08/31/05
CCC: B
------------=------------- Structure Information --- I
Type TYPE V,- NON RATED
Occupancy Type DWELLG/LODGING/LONG <=10
Flood Zone. . . . . . . . . NON -AO FLOOD ZONE
Other struct info . . . . CODE EDITION 2001CBC
FIRE SPRINKLERS.. NO
GARAGE SQ FTG 809.00
PATIO SQ FTG 394.00
NUMBER OF UNITS 1.00
FIRST FLOOR SQ FTG, 2583.00
Permit . . . .. . BUILDING PERMIT
Additional desc
Permit Fee . . . 888.00 Plan'Check Fee .'144.30
Issue Date Valuation 170892
Qty Unit Charge Per Extension
'BASE- FEE 639.50
71.00 3.5000 THOU BLDG' .1.0 0, 0Q:1-500•, 0.0.0 248.50
-------------------------------------—-----------
——--------------
Permit . . . . . MECHAN,I CAL.
Additional desc .
Permit Fee .. . . . 130.50 Plan Check Fee 8.16
Issue Date Valuation 0
Qty Unit -Charge Per' Extension
BASE 'FEE- 15.00
P.O. Box 1504 • VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 10 4- , % %Q1LAvahitect
Date:
Applicant: or Enaineerl _
Applicant's Mailing Addres
�[� eI, q"tea
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 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 Licep�e is in full force and effect. 4 �T
, - _-nse Class
u ,cense No. -:29
/Date 3 tractor l �f%P,jl ►`'+�..!
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 1, 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.& 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 Numb r
V I certify that, in the performance of the work for ich this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
7_ compensation laws of Califomi a e a , if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those ovision
WARNING: FAILURE TO SECURE WORKERS' C'OMPENSATION 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 peg' that there is a construction lendin gen I the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
It
enders Name w;T av". ��-
Lender's Address AAal.0 Ocids b4o� 0
✓ 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 es 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 wo b in, performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and vo' o is not commenced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to lation.
I certify that I have read this application and state that the ab a inform 'o . co e . agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this unty to enter on t o e -mentioned property for inspection purposes.
Date 4: nature (Applicant or
Page
2
Application
Number
04-00003790
Date
4/29/04,
Qty
Unit Charge
Per
Extension
3.00
9.0000.EA
MECH
FURNACE <=100K
27.00
3.00
16.5000
EA
MECH
B/C >3-15HP/>100K-500KBTU
49.50
5.00
6.5000
EA
MECH
VENT FAN
32,.50
1.00
6.5000
EA
MECH
EXHAUST HOOD
6.50'
Permit .
. . . . .
ELEC-NEW RESIDENTIAL
Additional
desc
Permit Fee
121.59
Plan Check Fee
8.54
Issue Date
. . . .
Valuation
0
Qty
Unit Charge
Per
Extension
BASE
FEE
15.00
2583.00
.0350
ELEC.NEW
RES - 1 OR 2 FAMILY
90.41
809.00
.0200
ELEC
GARAGE OR NON-RESIDENTIAL
16.18
.00
15:0000
EA
ELEC
TEMPORARY POWER POLE
.00
Permit .
. . . . .
PLUMBING
Additional
desc
Permit Fee
. . . .
169.50
Plan Check Fee*.
9.66
Issue Date
Valuation
0
Qty
Unit Charge
Per
Extension
BASE
FEE
15.00_
16.00
6..0000
EA
PLB
FIXTURE
96.00
1.00
15.0000
EA
PLB
BUILDING SEWER
15.00
'1.00
7.5000
EA
PLB
WATER HEATER/VENT
7.50
1.00
9.0000
EA
PLB
LAWN SPRINKLER SYSTEM
9.00
8.00
1.5000
EA
PLB
VACUUM BRKR >5
12.00
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
30, PLAN 1/CT.
PERMIT
DOES NOT.
Page 3
Application Number . . . . .
04-00003790
Date
4/29/04
-------=-------------------------------------------------7------------------
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
14.43
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
16.13
DIF'STREET
MAINT FAC -RES
15.00
DIF
TRANSPORTATION - RES
1098.00
Fee summary Charged
-----------------
Paid Credited
Due
----------
Permit Fee Total 1324.59
----------
---------- ----------
.00 .00
1324.59
Plan Check Total 170.66
.00 .00
170.66
Other Fee Total 2435.56
.00 .00
2435.56
Grand Total- 3930.81
.00 .00
3930.81
Sent By: AMPAM-LDI;
Santa Rosa Trail
909 340 9688; May -12-05 8:48; Page 7
Site Address Permit #
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).
RVAC SYSTEMS:
# of
Effeciency
Duct
Hewing Equipment
(pkg. heat
CEC Certified Compressor Unit
Identical
(SEER, etc)'
;
Equip. Type
# of
Efficiency
Duct
Duct or
Heating Heating
(pkg. hent CEC Certified Mfr, Make &
Identical
(AFUE,etc.)'
Location
Piping
Load Capacity
pump, etc.) Model Number
Systems
[aCF-1R value)
(attic, etc.)
R -value
(Btu/hr) (BTU/Hr)
FAU CARRIER 58STXIID122
1
80.0%
ATTIC
R-4.2
110,000
FAU CARRIER 59STX090116
1
80.0%
ATTIC
R-4.2
90,000
Cooling Equipment
Equip. Type
# of
Effeciency
Duct
Cooling Cooling
(pkg. heat
CEC Certified Compressor Unit
Identical
(SEER, etc)'
Location
Duct
Load Capacity
pump, etc.)
Mfr. Name and Model Number
Systems ,'
[2CF-I R value]
(attic, etc.)
R -value
(Btu/hr) (B -I U/Hr)
A/C COND.
CARRIER 39BRC06MO
1
12
ATTIC
R-4.2
60,000
A/C COND.
CARRIER 38RRC049000
1
12
ATTIC
R-4.2
48,000
1 >_ reads greater than or equal to.
I, 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 (Forth CF -I 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 LD1 Mechanical
Jenniferizu tl 5/11/2005 HVAC Subcontractor (Co. Name)
Yp
OR General Contractor OR Owner
WATER HEATVgG SYSTEMS:
Water CEC Certified Distribution IfRecir- Rated Input Tank Efficiency Standby Extcrual
Heater Mfr Name & Type (Std, culation, # of Identical (kW or Volume (EF, RE) Loss (%) Insulation R -
Type/# Model Number Point -of -Use) Control Type Systems Btu/br) (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.
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.
Signature, Date
M
COPY TO: Building Department
HERS Provider (if applicable)
Building Owner at Occupancy
RCR COMPANIES
Plumbing Subcontractor (Co. Name)
'OR General Contractor OR Owner
f
05/11/2005 08:48 951-686-8786
Westen
RESIDENTIAL
WESTERN INSULATION
FpM
PAGE 05/17
4211 Latham Street - Riverside. California 92501 - Phone: (909) 688-8760 - Fax: (909) 686-8786
4484
CF6R INS LiiLATIONCERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT.
TRACT/PHASE: SANTA ROSA TRAILS /PHASE 1
LOT 30
SITE ADDRESS_ - - - -57.862 SANTA ROSA TRAILS LA QINTA, CA - - - - - - - - - - - - -
EILI GS: BLOWN INSULATION
MANUFACTURER: GREENFIBER THICKNESS: 10.3" R- VALUE: R-38
CEI GS: BATTS
MANUFACTURER: KNAUF THICKNESS: 12" R- VALUE: R-38
CEILINGS: BATTS
MANUFACTURER: KNAUF THICKNESS: a Y4 R- VALUE: R-19
INTERIOR WALLS: BATTS
MANUFACTURER: KNAUF THICKNESS: 3 %:" R — VALUE: R-11
GENERAL CONTRACTOR: GREYHAWK HOMES
BY:
TITLE:
DATE.
r
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
TITLE: PRODUCTION NAGER
DATE: MAY 11, 2005
r
1
1
- Certificate of Occupancy0
5w��
C� OF'T9� 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 cmpliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 57-862 SANTA ROSA TRAILS
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 04-3790
Occupancy Group: R3 Type of Construction: V -N Land Use Zone: RL
Owner of Building: SANTA ROSA DEVELOPMENT Address: 40847 SANDPIPER CT.
City, ST, ZIP: PALM DESERT, CA 92260
By: STEVE TRAXEL
Date: APRIL 1, 2005
Building Official
POST IN A CONSPICUOUS PLACE