BWFE2014-1128LICENSED 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 Professions Code,
and my License is in full force and effect.
License Class: B. A License No.: 690645.
Dat e`se" y.� — 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 or she 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).:
(_)-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.).
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.).
(_) 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 is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
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 ork for which this permit is issued.
jc-jr,�3;700
have and will maintain workers' compensation insurance, as required by
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: Policy Number:
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 to the
Workers' compensation provisions -of Section 3700 of the Labor Code, I shall -forthwith
comply with those provisions.
Ap
C Applicants h X `
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UPTO
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 Building Official for a permit subjzct 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 perm:,,t
issued as a result of this application , the owner, and the applicant, each agrees b, and
shall defend, indemnify and hold harmless the City 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 orrect.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter. upon the above-
mentioned property for inspection purposes.
do 4�7
Date: — Signature (Applicant or Agen
4
VOICE (760) 777-7125
78-495 CALLE TAMPICO
FAX (760) 777-7011INTA,
LA QUCALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/24/2014
` Application Number:
BWFE2014-1128
Owner:
Property Address: "
80031 SILVER SAGE LN
RJT HOMES CODORNIZ
APN:
777450009
1425 E UNIVERSITY DR
Application Description:
45 LF BLOCK WALL
PHOENIX, AZ 0
Property Zoning:
w
Application Valuation:
$2,250.00
0 0
Applicant:Contractor:
RJT HOMES, CODORNIZ
R 1 T INVESTMENTS INC
_�
® 5 0
1425 E UNIVERSITY DR
PO BOX 6089
0
PHOENIX, AZ 0LA
QUINTA, CA 92253
Qit
(760)564-6555
Q r
Llc. No.: 690645
�f
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 Professions Code,
and my License is in full force and effect.
License Class: B. A License No.: 690645.
Dat e`se" y.� — 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 or she 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).:
(_)-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.).
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.).
(_) 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 is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
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 ork for which this permit is issued.
jc-jr,�3;700
have and will maintain workers' compensation insurance, as required by
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: Policy Number:
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 to the
Workers' compensation provisions -of Section 3700 of the Labor Code, I shall -forthwith
comply with those provisions.
Ap
C Applicants h X `
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UPTO
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 Building Official for a permit subjzct 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 perm:,,t
issued as a result of this application , the owner, and the applicant, each agrees b, and
shall defend, indemnify and hold harmless the City 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 orrect.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter. upon the above-
mentioned property for inspection purposes.
do 4�7
Date: — Signature (Applicant or Agen
�.
9
�r
Description: 45 LF BLOCK WALL
,
Type: WALL/FENCE
Subtype: Status: SUBMITTED
Applied: 11/24/2014 MFA
Approved:
Parcel No: 777450009 Site Address: 80031 SILVER SAGE LN LA QUINTA,CA 92253
Subdivision: TR 32070
Block: Lot: 9
Issued:
Lot Sq Ft: 0
-Building Sq Ft: 0 Zoning: '
Finaled:
Valuation: $2,250.00
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
<• :, a
Details: 45 LF BLOCK WALL [CITY
AND PROTO If C -DIP FOOTING SPECIFICATIONS] PRECISION CONCRETE BLOCK SHALL BE COVERED WITH
STUCCO, PAINT, OR TEXTURED COATING WHERE VISIBLE FROM OUTSIDE THE PROPERTY. 2010 CALIFORNIA BUILDING CODES.
Printed: Monday, November 24, 2014 3:44:38 PM 1 of 2 CR?WYSTEMS
IIIIIIIIIIEKsl 1 1 DI k 11 W 1
CONTACTS
INFORMATION
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APPLICANT
RJT HOMES CODORNIZ
1425 E UNIVERSITY DR PHOENIX
AZ
0
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CONTRACTOR
R J T INVESTMENTS INC
PO BOX 6089 LA QUINTA
CA
92253
BSAS SB1473 FEE 101-0000-20306
OWNER
RJT HOMES CODORNIZ
1425 E UNIVERSITY DR PHOENIX
AZ
0
Total Paid for BUILDING STANDARDS ADMINISTRATION
Printed: Monday, November 24, 2014 3:44:38 PM 1 of 2 CR?WYSTEMS
INFORMATION
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Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00
$0.00
BSA:
Printed: Monday, November 24, 2014 3:44:38 PM 1 of 2 CR?WYSTEMS
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$0.00
100 LF PC
Total Paid forFENCE OR FREESTANDING WALL $108.77 $0.00
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INSPECTIONS
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# `f DATE'S 4
BOND BEAM
FOOTINGS
FINAL"
PARENT PROJECTS
Printed: Monday, November 24, 2014 3:44:38 PM 2 -of 2 CRWIYSTEMS
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
Permit #
Project Address: —03 5JLVC-P- E_Owner's
Name: RJT Homes - Codorniz, LLC
A. P. Number:
Address: P.O. Box 6089
Legal Description:
Contractor: RJT Investments, Inc.
City, ST, Zip: La . Qu i n t a, CA 92248
Telephone: 760-564-6555
Project Description:
Address: P.O-. Box 6089
City, St, Zip: L•a Qu i nt a , CA 92248
,q,QD6,/IA77p hl'iY� —
Telephone: 760-564-6555
" • '
S L►MCA (L FT'
State Lia#: 690645 City Lie.#, 6089
Arch., Engr., Designer.
Address:
City, ST, Zip:
t
Telephone:
:
G
Construction Type: R�/1)fArftfcupancy:
State Lie. #:
Project type {circle one)- ow Add 'n . Alter Repair Demo
Name of Contact Person: '� • 1
!✓1 yV1 fi �`r j/V
--4-Estimated
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: '760 e� - (43,
av
Value of Project: v zzSU
0
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
�('Z
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
PIan:Check Balance.
Tide 24 Calc..
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
211 Review, ready for correcdonossue
Electrical
Subcontector List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for correctionVissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
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