05-4623 (SFD)�x
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w +.
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4'yl 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: OS -00004.623
Property Address: 52122 ROSEWOOD LN
APN: 772-410-997-32 -3207.0 -
Application description: DWELLING - SINGLE FAMILY DETACHED
Property Zoning: MEDIUM -HIGH .DENSITY RES y
Application valuation: 101048
Applicant:
rchitect or Engineer:
Owner:
RJT HOMES - CODORNI_Z
P.O. BOX 810
UINTA, CA 92253
Itractor:
RJ HOMES LLC
1 5 E. UNIVERSITY DRIVE
P OENIX, AZ 85034
60)123-4567
Lic. No.: 690645
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/14/05
------------------------------------=------------
- LICENSED CONTRACTOR'S DECLARATION -
-
---------_--------------------------------------
WORKER'S COMPENSATION DECLARATION '
I hereby affirm under penalty of perjury that I am licensed unde visions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations: .
Section 7000) of Division 3 of the Business and Profes ' ode, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: A -B License No.: 690645
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
ateii ontractor:
issued.
1 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 DECLARATION
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 STATE FUND Policy Number 0014793-2005
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 which 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 become subject to the g%kers' 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 should become subject to ers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
370�olthe abor Code,I shall forth ' om ly with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 byany
applicant for. a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
ate�0 'lt:
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
- I., .
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 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.).
( 1. 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 contractors) licensed
pursuant to the Contractors' State License Law.).
( ) .l am exempt under Sec. , B.&P.C. for this reason
Date: 4 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: %lam
Lender's Address: 1"
LQPERMff
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Applicationis 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 applicationand state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building co9pw6er09.,0 hereby authorize representatives
of thiscountyto enter upon th above-mentioned property f spe ' urposes.
pdfa: V gnature (Applicant or Agent):
Application Number
. . . 05-00004623
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
nn � 5n0n
----------------------------------------------------------------------------
Tuna Rr,nr
j-00, 0ni,=snn, 000
7.00
Permit
MECHANICAL
Additional desc .
Permit Fee . . . .
52.50
Plan Check Fee
3.28
Issue Date
Valuation . . . .
0
Expiration bate .'
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
L ------ --------------------'-------
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
Application Number f 05-00004623
' y • .. %Permit PLUMBING.
�`•; .. a' t Q 1Unit .Charge Per'; ^.
Qty
Extension•
s a
1:00 a` 7.5000 EA' PLB WATER HEATER/VENT :'' ...
..
.50
7.50/'
' 1.00 3.0000.,EA.. PLB WATER INST/ALT/REP "_
3'-00
'9.00'
1.00 9.0000�EA PLB LAWN SPRINKLER SYSTEM
5.00: 7500 EA PLB. GAS PIPE >=5 _
3.75
f
1.00 15.0000 EA PLB'GAS METER
r
-`-----------------------------------------------------'---------------
.Permit ;, ti GRADING PERMIT _ . • .
.,
. ..
Y Additional desc
,
'
Permit "Fee ♦ 15.00 Plan Check Fee .'
.00
' Issue. Date Valuation
0
'
Expiration Date »• 4/i2/06
Qtyr Unit "Charge •Per • �
Extension'
".
', • '
' BASE FEE
15.00
- Special Notes and.Comments `
- SFD - LOT_32, SF3SGA,'.1574 S.F. PERMIT
.DOES NOT -INCLUDE POOL;;SPA, BLOCK WALLS -�
_
'j'_' `' •
R DRIVEWAY APPROACH�
r O .. 75% REDUCTION TO'' 011BI. DG. P/'04 CEC/'OS.ENERGY
r." t. . •
PLAN CHECK FEES DUE TO .MULTIPLE
,
.
ISSUANCE OF SAME •PLAN• TYPE
•- �'' Other-FeesART IN PUBLIC PLACES -RES
20.00:
' -•'DIF•COMMUNITY CENTERS -RES
.: 97.00
DIF CIVIC CENTER RES -
366.00
,
ENERGY REVIEW FEE
10.51
< 1 DIF FIRE PROTECTION -RES
97.00•"
GRADING PLAN CHECK FEE,
.00
_ DIF LIBRARIES - RES
225:00."
,r -
' DIF PARK MAINT'FAC - RES
5.00
'DI'F PARKS/REC -'RES,
502.00,
i
• STRONG MOTION (SMI) - RES
�•'
"10.10
'
` DIF,STREET'MAINT FAC -RES
- 15.00
`
a DIF TRANSPORTATION - RES
1098.00
Charged' Paid Credited -
`
Due- '
_
• Perm t'Fe6 Total 935.24 :00 .00
935.24
Plan Check Total 122.17 00 .00
122:17
n
Other ;Fee Total.2445.61, f 00 :00
2445.61
-"Giand_Total '3503.02 .00 "�°•00,x. z
3503.02
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