06-1750 (BLCK)c&ty,, 4 Qum -
BOX 1504m VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
- Date: 5/04/06
Application Number: 06-00001750_ Owner:
Property Address: 52178 ROSEWOOD LN RJT HOMES - CODORNIZ
APN: 772-410-997-42 -32070 P.O. BOX 810
Application description: WALL/FENCE LA QUINTA, CA 92253
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 1150
Contractor:
Applicant: Architect or Engineer: RJT INVESTMENTS INC
1425 E. UNIVERSITY DRIVE
PHOENIX, AZ 85034'
/AA (602)257-1656
1 Lic. No.: 690645
.-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I amlicensed under provisions 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 Professionals Code, 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 o.: 690645
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
-Date��ntractor:
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 -B ILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exemp from the Contractor's State License Law for the
Carrier STATE FUND Policy Number 0460014793
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 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 should become subject to the workers' compensation provisions of Section
_ License Law (Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code) or _
3700 of the Labor Code,+I shall 1prthyvith comply with those provisions.. '
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).:
e�� ,cant:
( 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
.-9
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION C ERAGE 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 1N
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.).
APPLICANT ACKNOWLEDGEMENT
(_) 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, -
(_) I am exempt under Sec. , B.&P.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 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 thi ounty to enter upon he above-mentioned property r insp cti purposes.
a� 'nature (Applicant or Agent):
71
Application Number, 06-00001750"
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit.Fee 29.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 1150.
Expiration Date 10/31/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
7.00 2.0.000 HND BLDG 501-2,000
14.00
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Special Notes and Comments
46 L.F. 6' GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid
Credited
Due
Permit Fee Total - 29.00
.00
.00
29.00
Plan Check Total .00
.00
.00
.00
Grand Total. 29.00
.00
.00
29.00
r