09-0515 (SPIN)P.O. BOX 1504.,
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
09-00000515.
52289 ROSEWOOD LN
772-410-997-93 -32070
SPECIAL INSPECTION
MEDIUM HIGH DENSITY RES
100
Tit!t4-4Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDINGPERMIT ,
Owner:
RJT HOMES - CODORNIZ
P.O. BOX 810
LA QUINTA, CA 92253
Contractor:
RJT INVESTMENTS INC
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/22/09
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1425 E. UNIVERSITY DRIVE A .�
PHOENIX, AZ 85034
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UK
(602)257-1656
Lic. No.: 690645
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LICENSED CONTRACTOR'S DECLARATION
------------------------------------------------—
WORKER'S COMPENSATION DECLARATION
• I hereby affirm under penalty of perjury that I am licensed 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.
1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Cl s: A• 'B License No.: 690645
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
/ate: ntractor:-
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
_
Code, for the performance of the workfor which this permit is issued. My workers' compensation
- OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereb affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier LUMBERM INS Policy Number 288165
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 7000) of Division 3 of the Business and Professions Code) or
f the Labor Code, I shall forthw'th 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 (5500).:
&300
te:plicant: -
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
WAR ING:O SECURE WORK S' 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.). ' .
APPLICANT ACKNOWLEDGEMENT
1 _ 1 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.).
whosebenefit work is performed under or pursuant to any permit issued as a result of this application,
( 1 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
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 this cou y to nter upon the above-mentioned property for inspection p rposes.
ate: Si ' ature (Applicant or Agent):
LQPERMIT
Application Number
09-00000515
Permit . . .. .
. SPECIAL INSPECTION
Additional desc .
Permit Fee. . . .
100.00 Plan Check
Fee
.00
Issue Date . . .
. Valuation
100
Expiration Date
11/18/09
Qty Unit Charge Per
Extension
BASE FEE
100.00
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Speeial Notes and C otittnenLs
SPECIAL INSPECTION
TO ALLOW FINAL ON SFD
LAST INSPECTION ON
05-4612.WAS ON
10/3/07.(GAS TEST)
Fee summary
Charged Paid Credited
Due
Permit Fee Total
100.00 .00
.00
100.00
Plan Check Total
.00 :00
.00
.00
Grand Total
100.00 .00
.00
100.00
Bin #
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
,
r
Permit #
Project Address:
Owner's Name:
A. P. Number:
Address: C7
Legal Description:
City, ST, Zip:
Contractor:
Telephone:
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Address:
Project Description:
City, ST, Zip:
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Telephone:
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State Lic. # :
City Lic. #•:
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Arch., Engr., Designer:.
Address:
City., ST, Zip.
Telephone:
State Lic. #; .
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:':Y .•.:.`::;,:<•.::z:?:<::::t::«:.Occupancy:
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Construction Type:
Project type (circle one): New Ad -Fn Alter Repair- Demo
Name of Contact Person:
Sq. Ft.:#Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE. BELOW THIS LINE .
#
Submittal
Req'd '
Rec'•d
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit .
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction "
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2n1 Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked. up.
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
M Review, ready for correctionsrssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees