04-3655 (SFD)i
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA Q,UINTA,,CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
C) �yr'r
® J P✓� ,
Application Number 04--0-9-0-03-65-5 Dae 4/29/04
Property .Address 57903 SANTA ROSA"-TR Fs�
APN: 762-240-013-3 -304.8,7.::--:-
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 2001CBC
FIRE SPRINKLERS NO
GARAGE SQ FTG 710.00
PATIO SQ FTG 610.00
NUMBER OF UNITS 1.00
FIRST FLOOR SQ FTG 2747.00
--------------------------------------------------------------------•--------
Permit . . . . . . BUILDING PERMIT
Additional desc
Permit Fee . . . . 891.50 Plan Check Fee 579.48.
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 28.63
Issue Date Valuation . . . . 0
Qty Unit Charge Per
BASE FEE
Extension
.15.00
P.O. BOX 1504 • /i .
w VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING &c SAFETY DEPARTMENT
Application Number:
Date: 5/1
WklU
Applicant's Mailing Address:
ICY r E,ngir' tr 4`
chitecf or Engineer'Ad'-s
4 q— IOD kfY &-.P.
c. 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
Cod and my License 5 n full force and effect. �--
,cense Class__ License No. ` 78 2
Date on� GPe Y k11.,11r_
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.).
(_) I am exempt under Sec. BA P.C. for this reason
Date
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perury 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 th , if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those vision
WARNING: FAILURE TO SECURE WORKERS' COMPENSATt6N 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�'vTdi �%'•CcS� /l�G w M,O..N,L0
LOnder•s Address POI 1701}, 014 7 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 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.
I certify that I have read this application and state that the abov no ation rr . I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this co ty to ent t e bove-mentioned property for inspection purposes.
�02te .�' ignature (Applic t r Agent)
a
Application Number
. 04-00003655
Page 2
Date 4/29/04
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
1.00
--------------7-------------------------------------------------------------
6.5000
EA
MECH
EXHAUST HOOD
6.50
Permit .
. . . . .
ELEC-NEW RESIDENTIAL
Additional
desc
Permit Fee
. . . .
125:35
Plan Check Fee
35.09
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
49.88
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
3, PLAN 2/CT.PERMIT
DOES NOT
I
Page 3
Application Number
--------------------7-------------------------------------------------------
. . . . .
04-00003655 Date
4/29/04
Special Notes and
Comments
INCLUDE BLOCK WALLS,
POOL, SPA
OR
DRIVEWAY APPROACH
----------------------------------------------------------------------------
Other Fees .
. . . . . .
ART IN PUBLIC PLACES -RES
.00
DIF COMMUNITY CENTERS -RES
97.00
D.IF CIVIC CENTER - RES
366.00
ENERGY REVIEW FEE
57.95
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
693.08
.00 .00
693.08
Other Fee Total
2481.06
.00 .00
2481.06
Grand Total
4519.99
.00 .00
4519.99
Sent By: AMPAM-LDI;
909 340 9688; May -12-05 8:51; 'Page 13/19
I—ff—ULATION CERTIFICATE
CF -6R
57-903 Santa Rosa Tihail
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 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).
HVAC SYSTEMS:
Headng Equipment
Equip. Type
# of
Efficiency
Duct
Duct or
Heating
Heating
(pkg. heat CEG Certified MIF, Make &
Identical
(AFUE,etc.)'
Location
Piping
Load
Capacity
pump, etc.) Model Number
Systems
[ZCF-1 R value]
(attic, etc.)
R -value
(Btu/ltr)
(BTUfW)
FAU CARRIER 58STX110122
1
80.00/0
ATTIC
R4.2
110,000
EAU CARRIER 58STX090116
1
80.09.
ATTIC
R4.2
�—
90,000
Cooling Equipment
Equip. Type
# of
Effeciency
Duct
Cooling
Cooling
(pkg. heat CEC Certified Compressor Unit
Identical
(SEER, etc)'
Location
Duct
Load
Capacity
Dump. etc.) Mfr. Name and Model Number
Systems
[?-CF-1 R value)
(attic, etc.)
R -value
(Btuthr)
(BTU/Hr)
A/C COND. CARRIER 38BRC060000
1
12
ATTIC
R4.2
60,000
A/C COND. CARRIER 38BRC048000
1
12
ATTiC
R-4.2
48,000
1 k 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 (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 devices (from the Appliance Efficiency Regulations or Part 6), where applicable.
AMPAM LD1 Mechanical
Jen ' 5/11/2005 HVAC Subcontractor (Co. Name)
OR General Contractor OR Owner
WATER HEATING SYSTEMS:
Water CEC Certified Distribution IfRecir- I Rated Input Tank Efficiency Standby External
Heater M& Name & Type (Std, culation, # of Identical (kW or Volume (EF, RE) Loss (°h) Insulation R -
Type/# 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 I 11.
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 than the equipment
specified on the Certificate of Compliance submitted to demonstrate compliance with the Energy Efttclency 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
85/11/2885 88:48 951-686-8786 . WESTERN INSULATION PAGE 11/17
RESIDENTIAL
on L.P.
TRACTING
4211 Latham Street • Riverside, California 92501 • Phone: (909) 686-8760 • Fax: (909) 686-8786
CF6R INS
License
UI &TION CERTIFICATE
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:
TRACTIPHASE:
LOT
SANTA ROSA TRAILS I PHASE 1
3
SITE ADDRESS_ - - -
- - 57-9W SANTA ROSA TRAILS - LA OINTA, CA ,- - - - -
CEILINGS:
MANUFACTURER:
- - - -
BLOWN INSULATION F
GREENFIBER THICKNESS:
10.3" R- VALUE: R-38
CE --SGS'
BATTS
MANUFACTURER:
KNAUF THICKNESS: 12" R- VALUE: R-38
CEILINGS:
BATTS
MANUFACTURER:
KNAUF THICKNESS: 6 Y." R- VALUE: R-19
INTERIOR WALLS:
BAITS
MANUFACTURER:
KNAUF THICKNESS: 3 Ye ' R -VALUE; R-11
GENERAL CONTRACTOR: GREYHAWK HOMES
BY:
TITLE: "
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, L.P.
LICENSE NUMBER: 794484
BY:
TITLE: PROD CTIO ANAGER
DATE: MAY 11, 2005
0 -Certificate of Occupanc
-
r� ova
r 7
oF�9w Buildin &-•SafetY Department'
s 9►
This Certificate is issued pursuant to -the requirements of,Section-109 of the California Building Y ,
Code, certifying that, at 'the� time of issuance, this structure was ,ins compliance with the
provisions of the Building Code, and ,the various 'ordinances of the City regulating building; •_ -
`construction and/or use.... _
• - � � ' • : -BUILDING ADDRESS. 57-903 SANTA ROSA TRAIL
_ Use classification: SINGLE FAMILY DWELLING Building., Permit No.: 04-3655
Occupancy Group:- R3 Type of Construction: VN Land Use Zone:. RL� `..,
Owner of Building: SANTA ROSA DEVELOPMENT - Address:. 40847 SANDPIPER COURT
• � - - - ' � . u ... City;'ST; ZIP: PALM DESERT,"CA,92260-
By: GARY HARTMAN
•Date: MAY 11, 2005 ,,s
J
Building Official
' - POST IN A CONSPICUOUS PLACE :.
0 -Certificate of Occupanc
-
r� ova
r 7
oF�9w Buildin &-•SafetY Department'
s 9►
This Certificate is issued pursuant to -the requirements of,Section-109 of the California Building Y ,
Code, certifying that, at 'the� time of issuance, this structure was ,ins compliance with the
provisions of the Building Code, and ,the various 'ordinances of the City regulating building; •_ -
`construction and/or use.... _
• - � � ' • : -BUILDING ADDRESS. 57-903 SANTA ROSA TRAIL
_ Use classification: SINGLE FAMILY DWELLING Building., Permit No.: 04-3655
Occupancy Group:- R3 Type of Construction: VN Land Use Zone:. RL� `..,
Owner of Building: SANTA ROSA DEVELOPMENT - Address:. 40847 SANDPIPER COURT
• � - - - ' � . u ... City;'ST; ZIP: PALM DESERT,"CA,92260-