05-3085 (BLCK)_ P.O. BOX 1504 .
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 .
Application Number:
575-00003.C85)
Property Address:*
50025 VIA DE MODA
APN:
772-380-004- - -
Application description:
WALL/FENCE
Property Zoning:.
LOW DENSITY RESIDENTIAL
Application valuation:
3300
Applicant:
Architect or Engineer:
4
BUILDING'& SAFETY DEPARTMENT
BUILDING PERMIT
p W
L 25 2005
Owner:
R J. T HOMES -
1425 E UNIVERSITY DR
PHOENIX, AZ 85034
VOICE (760)'7-77-7012
FAX (760.) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/21/05.
JContractor:
RJT HOMES LLC
1425 E. UNIVERSITY DRIVE
PHOENIX, AZ 85034
(760)123-4567
Lic. No.: 690645
LQPERMIT
- -----------------------------------------------------
- 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
1 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 Class: A -B License No.: 690645
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is '
Y (Z�
5 ntractor. -/
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
�0ate:
/
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 under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier STATE FUND Policy Number 1583906
following reason (Sec. 7031.5, Busincos 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, 1 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 (Chapter9 (commencing with Section 7000) of Division -3 of the Business and Professions Code) or
3700 of the Labor Code, I hall forthwith comply with thorovisions .
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 per subjects the applicant to a civil penalty of not more than five hundred dollars ($5001.:
ate: 7 plicant: '"
as owner of the property; or my employees with wages as their sole compensation, will do the work; and
the structure isnot intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORK RS' 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, 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.
nrnflP-rtp whn hnilds or imnrnv?9 tharann, and who contracts fgr the Drgiect§ with (I GOntr9.(;19! j 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 A6V i5ei'Mit IssUea as a result or tnis appuuatwn,.. -.
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
' •
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.
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 build' g construction, and hereby authorize representatives
bove-mentioned or insp ion urposes.
-
Lender's Name: � � -
of this county to enter upon th propertt
'
�nature(Applicant
- jog. • ,
_.Date or.Agentl:
. - _-
Lender's Address:.
-
LQPERMIT
• Application Number 05-00003085'
1 Permit . . ... . . WALL/FENCE PERMIT
Additional desc
,Permit Fee` 63.00
Plan Check
Fee '.
.00
Issue Date
Valuation
3300
Expiration Date 1/17/06.
'
Qty Unit Charge Per
Extension
BASE. FEE
45.00 -
2..•00 9.0000'THOU BLDG 2,001--25,000
18.00."
Special Notes and Comments
132 L.F. 6' GARDEN WALL,,ORCO SYSTEM
Fee summary Charged Paid
Credited',Due
Permit Fee Total 63.00
.00
.00
63.00
Plan Check Total 00
-00
.00
0,0
Grand Total_ 63.00
.00
.00
63.00
4
LQPERMIT