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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 ��b 7 �c AG'tir D 1 1425 E. UNIVERSITY DRIVE A .� PHOENIX, AZ 85034 t^ UK (602)257-1656 Lic. No.: 690645 ------------------------------------------------ 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 ---------------------------------------------------------------------------- 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: ik::<• :s <:s.:s W? : ...... ,...:• moi: :•:;�: Address: Project Description: City, ST, Zip: n, Telephone: ,:; : a:•:•s: >': i?4•�: is ''f":n State Lic. # : City Lic. #•: < Arch., Engr., Designer:. Address: City., ST, Zip. Telephone: State Lic. #; . .... > <•': :: s>>::>::;:<::::>;<: ;, :':Y .•.:.`::;,:<•.::z:?:<::::t::«:.Occupancy: ::: >;i.;:;:;;•::•i:,::::r;;>:::»<:>:>z:>: 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