04-6500 (BLCK)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760) .777-7012
78-495 CALLE TAMPICO FAX (760); 777-7011
LA QUINTA, .CALIFORNIA 92253. INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number X04-0000650.0 Date 9/28/04
Property Address . . . . . CS -0460 VIA AMANTE
APN: 772-400-051- - -
Application description WALL/FENCE
Property.Zoning . . . LOW DENSITY RESIDENTIAL
Application valuation 2300
Owner Contractor
-=-----=---------------- -----------------------
R.J T HOMES RJT HOMES LLC
1425 E UNIVERSITY DR 1425 E. UNIVERSITY DRIVE
PHOENIX AZ 85034 PHOENIX AZ 85034..
WCC: STATE FUND
WC: 1583906 10/01/04
CSLB: 690645 06/30/06.
CCC: . . A -B
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Permit . . . . . . WALL/FENCE PERMIT
Additional desc
Permit Fee: 54.00 Plan Check Fee .00
Issue Date Valuation . . . . 2300
Qty 'UnitCharge Per Extension
BASE FEE 45.00
1.00 9.0000 THOU BLDG 2,001-25,000 9.00
Special Notes and Comments
92 L.F. 6' GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid Credited Due
Permit Fee Total 54.00 .00 .00 54.00
Plan Check Total, .00 00 .00 .00'
Grand Total 54.00 .00 .00 54:00
3 ( 2004
CITY CF LA QI JIFITA
FINANCE DEPT.
P.O. BOC 1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
VOICE (760) 777.701
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
�rAWT/M
Architect or Engineer's Address:
N 1A
Lic. No.:
BUILDING PERMIT DECLARATIONS
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 Professionals
C90e,and my License is full force and effect. �D
icense Class �-� cense No.
,-D-.te ontractor P'T;'t
OWNER49UILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).):
U 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 or 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-builcer will have the burden of proving that he or she did not build or improve for the purpose of sale.).
U I, as owner of the property, am exclusively contractinc 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.).
U 1 am exempt under Sec. . BA P.C. for this mason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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 the work for which this permit is 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
i ued workp�r§ com ep{�sation insyrar�ca carver and p umrbeer �/'�
arrier y 'Tr, �l p(b acv Number C�(L
_ I certify that, in the pertormanceeo tthe work far 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' oompensabon provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
WARNING: 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 ($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.
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
APPLICANT
ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director o1 Buildingand Safety A
1. Each person upon whose behalf this application is made, each person at we whose request rmit a d forto the whosewhose benefit wocti
rk snditions and resbi nperfo s set forted under or puorth on this rsuant to an
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City o1 La Ouinta, its
��rt
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 rep r sentatives of this county to ent r Pon the above-mentionedro rt for
P Pe Y inspection purposes.
/Gate �" (� Signature (Applicant or Agent):