13-0421 (SFD)P.O. BOX 1504 KIM
78-495 CALLE TAMPICO ✓
LA QUINTA, CALIFORNIA 92253 , , BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 13-00000421 Owner:
Property Address: 80055 -SILVER SAGE IN RJT HOMES C
APN: 772-410-997-13 -32070 1425 E UNIV
Application description: DWELLING = SINGLE FAMILY DETACHED PHOENIX, AZ
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 9877.2-
Applicant:
8772
Applicant:
Architect or Engineer:
VOICE 760 777-7012
FAX (760) 777-7011 •
INSPECTIONS (760) 777-7153
Dater 4%10/13
k04
Z
TD
112013
CITY OF LA QUINTA
Contractor: r-INANCE DEPT.
RJT INVESTMENTS INC
1425 E. UNIVERSITY DRIVE
PHOENIX, AZ 85034
(602)257-1656
Lic. No.: 690645
------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION'.
r
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencingwith
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 Cla B 1 ironse No.: 690645
for by Section 3700 of the Labor Code, for. the performance of the work for which this permit is
r.
ate: Contractor.I
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
OWNER -BUILDER DECLARATION -
insurance carrier and policy number are:
- I hereby affirm underpenalty of perjury that I am, exempt from the Contractor's State License Law for the
Carrier LUMBERMEN' S UND Policy Number 424430
- following reason ISec. 7031 .5, Business and Profession's 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
3 00 of the Labor Code, I shall forthwith 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
!'' /
;%jL�y
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date:271 Applicant: JQIP / -
PP
(_ 1 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
WARNING: FAILURE TO SECURE WORKERS' 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 1$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.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_•) I am exempt under Sec. -, 8.&P.C. for this reason '
the owner, and -the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
- -
of La Quinta, its officers, agents and employees for any actor omission related to the work being
performed under or following issuance of this permit:
Date: Owner:
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
CONSTRUCTION LENDING AGENCY
permit to cancellation.. -
I hereby affirm under penalty of perjury that there is a construction lending agency for the -performance of the
I certify that I have read this application.and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
Lender's Name:i%�A
of this cc�uyty tonter upon the above-mentioned property for in ection purposes.
-
0 Signature (Applicant or Agent): '. I — a••�+
Lender's Address:
rate:
_
LQPERMIT
LQPERMIT
Application Number
_- 13-00000421
------ Structure Information
1,504SF DWELIING/VB/RES-3/CL--A-FR/13D -----
Other struct info
CODE EDITION 2010
# BEDROOMS -
3.00
FIRE SPRINKLERS. 13D
GARAGE SQ FTG
462.00
PATIO SQ FTG
26.00
NUMBER OF UNITS
1.00
.1ST FLOOR SQUARE FOOTAGE
722.00.
---------=-------------------
2ND FLOOR SQUARE FOOTAGE
-----------------------------------------------
782.00
Permit
BUILDING PERMIT
Additional desc .
Permit Fee
635.00 Plan Check Fee
412.75
Issue Date . . . .
Valuation
98772
- Expiration Date
10/07/13
Qty Unit Charge
Per
Extension
BASE FEE
414.50
49.00 4.5000
THOU BLDG 50,0017100,000
220.50
Permit
ELEC-NEW RESIDENTIAL
Additional.desc .
Permit Fee . . .
76.88 Plan Check Fee
19.22
Issue Date
Valuation
0
Expiration Date—
10/07/13
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1504.00 .0350
ELEC NEW RES - 1'OR 2 FAMILY
52.64
462.00 .0200
ELEC GARAGE OR NON-RESIDENTIAL
9.24
Permit . . . . .
GRADING PERMIT
Additional desc .
Permit Fee
15.00 Plan Check Fee
.00
Issue Date
Valuation . . . .
0
Expiration Date
10/07/13
Qty Unit Charge
Per
Extension
----------------------------------------------------------------------------
BASE FEE
15.00
Permit
MECHANICAL
Additional desc .
Permit Fee . .
73.00 Plan Check Fee
18.25
LQPERMIT
LQPERMIT
Application Number . . . 13-00000421,
Permit . . . MECHANICAL
Issue Date Valuation
0
Expiration Date 10/07/13
"Qty Unit.Charge Per.
Extension
BASE FEE
15.00
1.00 9.0000 EA MECH FURNACE <=100K
9.00
1.00 "16.5000 EA MECH B/t >3-15HP/>100K-500KBTU
16.50
4.00 6.5000 EA MECH VENT FAN
26.00
1.00 6.5000 EA MECH EXHAUST HOOD
----------------------------------------------------------------------------
6.50
Permit PLUMBING
Additional desc .
Permit Fee 140.25 Plan Check Fee
35.06
Issue Date Valuation . . .
0
Expiration Date 10/07/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
12.00 6.0000 EA PLB FIXTURE
72.00
1.00 15.0000 EA PLB BUILDING SEWER
15.00
1.00 7.5000 EA PLB WATER HEATER/VENT
7.50
1.00 3.0000 EA 'PLB WATER INST/ALT/REP
3.00
1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM
9.00
5.00 7500 EA PLB GAS PIPE >=5
3.75
1.00 15.0000 EA PLB GAS METER,
-------------------------
15:00
Special Notes and Comments
1,504SF DWELLING - PLAN SF2AR, LOT 13
[VB/RES-3/CLASS A-FR/13D/ENGINEERED]
THIS PERMIT DOES NOT INCLUDE BLOCK WALLS
OR WATER FEATURES. 2010 CALIFORNIA
' BUILDING CODES.
April 8, 2013 10:31:40 AM AORTEGA-
-----------------_---------------------------
Other Fees ART IN PUBLIC PLACES -RES
20.00
BLDG STDS ADMIN (SB1473)
4.00
DIF COMMUNITY CENTERS -RES
104.00
DIF CIVIC CENTER - RES.
1089.00
ENERGY REVIEW FEE
41.28
° DI F. FIRE PROTECTION -RES
612.00
GRADING PLAN CHECK FEE
.00
DIF LIBRARIES - RES
334.00
MULTI -SPECIES (MSHCP) FEE
521.00
DIF PARK MAINT FAC - RES
51.00
DIF PARKS/REC - RES
1773.00
STRONG MOTION (SMI) - RES
9.88
LQPERMIT
Application Number
. . . .
13-00000421•
--------.---------_----------
• Other Fees
---------------------
DIF'STREET MAINT FAC-RES
158.00
DIF TRANSPORTATION - RES
3592.00
Fee summary
Charged
----------
Paid Credited-
----
Due
-----------------
Permit-Fee Total
940.13
.00 00
940.13
Plan Check Total
485.28
.00 .00
485.28
Other Fee Total
8309.16
.00- .00
8309.16
Grand Total
9734.57
.00• .00_
9734.57