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05-4636 (SFD)s � - P.O � BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoninq: Application valuation: Applicant: T4ht 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT C5_00004636 5 -2169 --ROSEWOOD LN 772-410-997-136 -32070 - DWELLING —SINGLE FAMILY DETACHED MEDIUM HIGH DENSITY RES 88677 rchitect or Engineer: r 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 dmy License is in full force and effect. License Class: A -B se No.: 690645 Date�� ntr.ct.r Owner: RJT HOMES - CODORNIZ P.O. BOX 810' A QUINTA, CA 92253 A (�2Q05o tractor: R Qp� J HOMES LLC 14 E. UNIVERSITY DRIVE NIX, AZ 85034 (760)123-4567 Lic. No.: 690645 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 for 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 Icommencing 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):: 1 ) 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.). (_ 1 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.). 1 _ 1 Jam exempt under Sec. B.&P.C. for this reason 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: OW LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/14/05 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 issued. YL 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 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 tote workers' compensation provisions of Section 3700 of the Labor Code, I shall fomply with those provisions. w�Y Applicant: 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 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 above informati is correct. I agree to comply with all city and county ordinances and state laws relating to building con , and hereby authorize representatives of [his Ooun t ter upon a above-mentioned property for ' tion purposes. D/ate/! gnature (Applicant or Agent): Application Number . . . . . 05-00004636 Permit BUILDING PERMIT Additional desc . - Permit Fee . . -590.0.0 Plan Check Fee 95.88 Issue Date . . . Valuation . . . . 88677 Expiration Date 4/12/06 Qty. Unit Charge Per Extension BASE FEE 414.50 : 39.00 4.5000"TH0U. BLDG 50,001-100,000 175.50 Permit . . MECHANICAL Additional desc.. Permit Fee 46.00 Plan Check Fee 2.88 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 1.00 6.5000 EA MECH VENT FAN 6.50 1.00 6.5000 EA MECH EXHAUST HOOD 6.50 Permit . . . ELEC-NEW RESIDENTIAL Additional desc . Permit Fee 72.72 Plan Check Fee 4.55 Issue Date . . . . Valuation . . . . 0 Expiration Date 4/12/06 Qty Unit Charge 'Per Extension BASE FEE 15.00 1385.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 48.48 •462.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL• 9.24 Permit . . . PLUMBING Additional desc . Permit Fee 128.25 Plan Check Fee 8.02 Issue Date . . . . Valuation . . . . 0 Expiration Date .. 4/12./06 Qty Unit Charge Per Extension BASE FEE 15.00 10.00 6.0000 EA PLB FIXTURE 60.00 1".00 15.0000 EA PLB BUILDING SEWER 15.00 ae9 Application Number . . . . ` 05-00004636 ' Permit . ' . . . . eLoMaz»nG ' ' Qty Unit Charge Per Extension ` 1.00 7.5000 EAeLB vmxroR HEATER/VENT 7.50 ^- 1.00 3.0000 EA eLa vmxrER REe . ].OU 1.00 9.0000 EA eLB�zaumm oPazmou�Ea oroToM 9.00 5.00 .7s00 EA rLa 8A8 pzeo ^~53.75 1'00 15.0000 Eu rLB GAS METER --___--_---_--__---------------_-----------------_----_-_-__-_ 15.00 Pezmit . . . ' ' . GRADlNG PERMIT Additional deoc . . Permit Fee . . . . 15.00 rIao Check nee . . .VO zonoe Date . . . .'Valuation . . . . o Expiration Date . . 4/12/06 Qty Unit Charge Per Extension BASE FEE I5.00 --__----------______-_-'----------------------_-----_-_--_----_- SpeciaI Notes and Comments SFo - LOT 136, gzAux SF2A' 1385 S.F. ' PERMIT DOES NOT INCLUDE POOL, oPu' BLOCK WALLS OR DRIVEWAY APPROACH. 75% aoDncTIom To PLAN CHECK FEES DUE TO om7LrzgLo ISSUANCE OF oxmxE PLAN Tzro ----------------------------------------------_----------------------------- otber Fees . . ' . .. . . . . DIF COMMUNITY CENTERS -RES 97.00 DIF CIVIC CENTER - RES 366.00 ` oaosRor Ronzow rEo/ e.s9 DIF nzRo PROTECTION -RES 97.00 ozr LIBRARIES - RES 225.00 DIF PARK omAzNr FAC - RES 5.00 . DIF PARKSIREC - RES 502.00 STRONG MOTION (SMI) - RES 8.86 DIF Szaooz omAzNr FAC -RES 15.00 ` DIF TeamoeORTxTI0m - RES 1098.00 Fee summary Charged raid Credited ------------- one --------- -------- --------- -------- eezmit Fee Total 85I.97 .00 .00 851-97 Plan Check -Total 111.33 OO. .UU 111.33 Other Fee Total 2423.45 _OO .00 2423.45 Grand Total ' 3386.75 .00 'OO 3386.15 uQPauMo ` ,