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14-0280 (BLCK)1, . P:O. BOX 1504 78-495 CALLE TAMPICO - LA QUINTA, CALIFORNIA 92253 4 - * A -0 BUILDING &SAFETY DEPARTMENT BUILDING PERMIT Application Number.14� �i 00000280 WORKER'S COMPENSATION DECLARATION Owner: Property Address: 52058—ROSEWOOD IN RJT HOMES - CODORNIZ APN: 772-410-997-26 -32070 - P.O. BOX 6089 Application description: WALL/FENCE issued. _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor LA QUINTA, CA 92253 Property Zoning: MEDIUM HIGH. DENSITY RES (760) 564-6555 ^,ppliootion Valuation: rr0 I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier LUMBERMEN' S UND Policy Number 429034 following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to Contractor: Applicant: Architect or Engineer: RJT INVESTMENTS INC q and agree that, if I sho becomesu ec t rkers' compensation provisions of Section ". License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 1425 E. UNIVERSITY D C�A`�l ✓ 1 `� PHOENIX, AZ 85034 (_ I I, as owner of the property, or my employees with wages as their sole compensation, will do the work, andthe (602)257-1656 )k WARNING: FAILURE TO SECURE WORK RS' COMPENSATIO OVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, LiC. No.: 690645 LLC I VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (7 60) 777-7153 Date: 3/20/14 lk'!6�ii - 31 ;,f s 4 i i IVB "Pf�d7� �yA �L - --------------- LICENSED CONTRACTO S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under pr isions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: " Section 7000) of Division 3 of the Busine nd Profess' d and my License is in full force and effect. - _ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: A B ns No.: 690645 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is % Dater actor. , Contr 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 OWNER- BUILDER D RATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier LUMBERMEN' S UND Policy Number 429034 following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for whi this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure,,prior to its issuance, also requires the applicant for the person in any manner so as to becomes bject to a workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I sho becomesu ec t rkers' compensation provisions of Section ". License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor e I shall fo wiy ompl ith those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031e5,by__, any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: - _...� ✓Z'L ~Applicant: (_ I I, as owner of the property, or my employees with wages as their sole compensation, will do the work, andthe structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The )k WARNING: FAILURE TO SECURE WORK RS' COMPENSATIO OVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN - improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. , 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 J. APPLICANT ACKNOWLEDGEMENT (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director'of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. _ property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_ 1 I am exempt under Sec. , BAP.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City Date: .Owner: 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: LQPERMIT of La Quinta, 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 w rk is not commenced within 180 days from date of issuance of such permit, or cess . n of w k for 180 days will subject permit to cancellation. I certify that I have read this application and state that the ove inform ion i r I agree to comply with all city and county ordinances and state laws relating to b ' di g cons truc on, a h authorize representatives . of this county to enter upon the above-mentioned a for inspec on rpo s. Date:,t �Signa_tu�re (Applic'ant-or-Agend: Application Number . . . . . 14-00000280 Permit . . . . . . WALL/FENCE PERMIT 2013 Additional desc . Permit Fee . . 47.19 Plan Check Fee .00 Issue Date . . . . Valuation . . . Expiration Date 9/16/14 .550 Qty Unit Charge Per Extension 1.00 47.1900 LSMISC WALL, FIRST 100 LF 47.19 ---------------------------------------------------------------------------- Special Notes and Comments 22 LNFT X 6 FT HT GARDEN WALL [ORCO SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM . OUTSIDE THE PROPERTY. 2013CBC -----------------_-_-------------------------------------------------------- Other Fees . . . . . ... BLDG STDS ADMIN (SB1473) 1.00 PLAN CHECK, WALLS 60.06 ` Fee summary Charged Paid Credited Due Permit Fee Total 47.19 .00 .00 47.19 Plan Check Total .00 .00 .00 .00 Other Fee Total 61.06 .00 .00 61.06 Grand Total 108.25 .00 .00 108.25 Bin # City of La Quinta Bulfding 8r Safety Dlv[slon P.O. Box 1504,78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Shea Permit # I, Project Address; _d e Lh Owner's Name: RJT Homes - Codorniz, LLC A. P. Number: _ o — ft Address: P.O. Box 6089 Legal Description: Contractor: RJT Investments, Inc. City, ST, Zip: La Quinta, CA 92248 Telephone: 760-564-6555 Address: P.O. Box 6089 Project Description: City, ST, Zip: L•a Quinta, CA 92248 6F q` l ©� j Telephone: 760- 564- 6555 �% r State Lia#: 690645 City Lie.#, 6089 Arch., Engr., Designer. Address: City, ST, Zip: Telephone: State Lie. #: Name of Contact Person: '-Fop, ConstructionType: SI Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: -' 716 ` Estimated Value of Project: p � APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACMG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calm Reviewed, ready for corrections Plan Check Deposit Truss Calls. Called Contact Person Plan Check Ralaice Title 24 Cala. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrections/issue Electrical Subconlector List Called Contact Person Plumbing Grant Deed Plans picked up S.M.L H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready for corrections/issue Developer Impa:t Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit Issue School Fees Total Permit Fees •,�• ! /`//� C!. I ^i- V!. •moi —// [.[�� f r� T .a�..-al '1 l r' I ; ? ° �' •moi r - r q �'1': ✓ r` �• I r Y � L Iry ; t � S VTt..y+ .. ;..., � � � �s+,•r • '�_�L7�.P � � `L ��,� ,I� �� �:.r..s r1L /- �:.•�,_� y I ill. i 1 7.57 GF : { ?; -.OF=2:1 �� � tom.• • I � 1 y � / ` • � N �• � ` c , 00� co AGF=27 f'n's �` •�1 t�� r -I VI ° '4.30 :Y� :7T '� -iEt: 2ti.. Ji '1 -�,"� ''i 1 ' .•''� RA it 1 ' �� _ I .M "� ..ti,✓ s T '><r.iN t1',q, a 'l pP 1 M _ '6 :moi• - �� . 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