07-2556 (SOTB)P.O. BOX 1504
78L495. CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT .
Application Number: 07-00002556 Owner:
Property Address: 52250 ROSEWOOD LN RJT HOMES - CODORNIZ
APN: 772-410-997-143 -32070 - P.O.. BOX 810
Application description: STRUCTURES OTHER THAN BUILDINGS LA QUINTA, CA 92253
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 17500
Applicant W 0111_
Com'
Architect'or Engineer:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70 1 of ivision 3 of the Business and Professionals Code, and my Licenseis in full force and effect.
License I s: -B nse No.: 690645
f Q�j r
Date: v� Contractor:
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 orshe 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).:
(_ 1 1, 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 ISec. 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 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 thein-, and who contracts for the projects with o contractor(s) Iicensod
pursuant to the Contractors' State License Law.).
1 _ 1 I am 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 isissued (Sec. 3097, Civ. C.).
Lender's Name: .
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/30/07
Contractor: SJ
RJT INVESTMENTS INC
1425 E. UNIVERSITY DRIVE
PHOENIX, AZ 85034
(602)257-1656
1
No.: 690645 �✓/�f�
------------------------------------ - ---
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, s provid
for by Section 3700 of the Labor Code, for the performance of the work for which this p it
issued.
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 LUMBERM INS' Policy Number 286010
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,
d agree that, if I should become subject to the workers' compensation provisions of Section
�6 0� 3700 of the Labor Code, I sh o thwith co with those provisions.
Date: Applicant:
r�
WAR NG' 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 1$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 upnn whnse he.half 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 information is correct. I agree to comply with all
city and co my ordinances and state laws relating to building construction, and hereby authorize representatives
of this o ty t enter upon the above-mentioned property for i p i n pur
Dat t Signature (Applicant or Agent):.
7 •
Application Number . . . 07=00002556
Permit . . .' . BUILDING PERMIT
Additional desc
.
Permit Fee 189.00 Plan Check
Fee
122.85 _
Issue Date Valuation
. . ..
.17500 -
_
Expiration Date 5/28/08
Qty Unit Charge Per
Extension
BASE•FEE
45.00
16.00 9..0000 THOU BLDG 2,001-25,000
144.00
-------------------------------------------------4--------------------------
". F
Permit . . . ELEC-MISCELLANEOUS T
Additional desc .
.Permit Fee22.50 '. Plan Check
Fee .'
10.06•
Issue Date . . .. Valuation
0
• Expiration Date 5./28/08
•Qty Unit. Charge Per
Extension
BASE FEE
15-00 ,
10.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
7.50
.00 18.5000 EA ELEC SVC <=600V/<=200A
.00
---------------------------------- - - - - -- - -- -
Special Notes and Comments
- -- -
-
(8) TENNIS COURT LIGHTS W/BASES LOCATED
AT CORDORNIZ CLUB HOUSE. 2001 CBC, 2004.''
CEC, NOT SUBJECT TO 2005 ENERGY CODE.
November. 14, 2.007 11:46:01 AM AORTEGA
Other Fees . . . . . .• . STRONG MOTION (SMI)
- COM
3.67
Fee summary. Charged Paid Credited
Due
Permit Fee Total 211.50• .00
.00 ;
211.50
Plan Check Total 132.91 .00
.00
132.91
Other Fee total 3.67 .00
.00
3.67
Grand Total 348.08 .00
.00
•348.08
•
LQPERDIIT
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t -