05-4624 (SFD)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: "�� 05=00004624_ j
Property Address: 52114 ROSEWOOD LN
APN: 772-410-997-31-32070—
Application description: DWELLING - SINGLE FAMILY DETACHED
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 101048 rr
Applicant: Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/14/05
Owner:
RJT HOMES - CODORNIZ
P.O. BOX 810
MQUINTA, CA 92253
OCT 2 8 2005 1 lintractor:
T HOMES LLC
sj�®��%i�)I�T� 1 25 E. UNIVERSITY DRIVE
R NAf�.l. P OENIX, AZ 85034
60)123-4567
Lic. No.: 690645
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 Code, a y License is in full force and effect.
LicenseClas : A -B o.: 690645
atel0 ��� ntractor:
- OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 foi the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's 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).:
(_) 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 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.).
(_) 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. , BAP.C. for this reason
/Date: i0wner:
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
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WORKER'S 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
VII/I1 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 STATE FUND Policy Number 0014793-2005
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 w9L4atlicompensation provisions of Section
3700 of the L or Code, I shall forthwith those provisions.
Dates pplicant:
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.
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 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 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�ounty to enter upon the ove-mentioned property f rposes.
ate/,�" Si ature (Applic or Agent)+
Application Number
. . . . 05-00004624
Permit
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
646.50
Plan Check Fee
105.06
Issue Date . .
Valuation
101048
Expiration Date .
4/12/06
Qty Unit Charge
Per
Extension
BASE
FEE
639.50
2.00 3.5000
THOU BLDG
100,001-500,000
7.00
Permit . . .
MECHANICAL
Additional desc .
Permit Fee
52.50
Plan Check Fee
3.28
Issue Date
Valuation . . . .
0
Expiration Date
4/12/06
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 9-.0000
EA MECH
FURNACE <=100K
9.00
1.00 9.0000
EA MECH
B/C <=3HP/100K BTU
9.00
2.00 6.5000
EA MECH
VENT FAN
13.00
1'.00 6.5000
----------------------------------------------------------------------------
EA MECH
EXHAUST HOOD
6.50
Permit . .
ELEC-NEW RESIDENTIAL
Additional desc .
Permit Fee . . . .
80.99
Plan Check Fee
5.06
Issue -Date . . . .
Valuation . . . .
0
Expiration Date .,
4/12/06
Qty Unit Charge
Per
Extension
BASE
FEE'
15.00 "
1574.00 .0350
ELEC
NEW RES.- 1 OR 2 FAMILY
55.09
545.00 .0200
-----------------------------------------------------------------------------
ELEC
GARAGE OR NON=RESIDENTIAL
10.90
Permit
PLUMBING
Additional desc .
Permit Fee . .". .
140.25
Plan Check Fee
8.77
Issue Date . . . .
Valuation . . .
0
Expiration Date ..
4/12/06
Qty Unit Charge
Per-
Extension
BASE
FEE
15.00'
12.00 6.0000
EA PLB FIXTURE
72.00
1.00 15.0000
EA PLB BUILDING SEWER
15.00
1
Application Number .
. . . . 05-00004624
Permit . . . . PLUMBING
Qty Unit Charge
Per
Extension
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
5.00 .7500
EA PLB GAS PIPE >=5
3.75
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
4/12/06
Qty Unit Charge
Per
Extension
BASE FEE
*15. 00
Special Notes and Comments
SFD - LOT 31, SF3SGB,
1574 S.F. PERMIT
0
DOES NOT INCLUDE POOL,
SPA, BLOCK WALLS
OR DRIVEWAY APPROACH.
75% REDUCTION TO -01 BLDG. M, P/ 04 CEC/ 05 ENERGY
PLAN CHECK FEES DUE TO
MULTIPLE
ISSUANCE OF'SAME PLAN
TYPE
Other Fees . . . .
. . . . ART IN PUBLIC PLACES -RES
20.00
DIF COMMUNITY CENTERS -RES
97.00
DIF CIVIC CENTER --RES
366.00
ENERGY REVIEW FEE
10.51
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
10.10
DIF STREET MAINT FAC -RES
15.00
DIF TRANSPORTATION - RES
1098.00
Fee summary Charged
Paid Credited
Due
Permit Fee Total
935.24 .00 .00
935.24
Plan Check Total
-122.17 .00' .00
122.17
Other Fee Total
2445.61 .00 .00
2445.61
Grand Total
3503.02. .00 .00
3503.02
LQPERMTT
�feca te - of Occupancy
Cert
-
.
- Oda&,
. .V. . . . . . .....
9w Building,. & Safet De artment.
OF 9► Y p
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, ti
BUILDING ADDRESS: 52-114 ROSEWOOD LN
G ,
Use classification: SINGLE FAMILYDWELLINGBuilding Permit No.: 05-4624
Occupancy Group: R-3 _ Type of Construction: VN Land Use Zone: RMH
3
r' Owner of Building: RJT HOMES- CODORNIZ .Address: P.O. BOX 810
Q j City, ST, ZIP: LA QUINTA, CA 92253 ,
By: STEVE TRAXEL
Date: OCTOBER 26, 2010
Building. Official
POST IN A CONSPICUOUS PLACE