05-00004285 (SFD)P.O. BOX 1504
X 78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA'
92253
Application Number:
C 05-0_0-0.04.2.8:5 `
Property Address:
50225 VIA DE MODA
APN:
772=380-009- - -
Application description:
DEMO - SINGLE FAMILY,
Property Zoning:
ESIDENTIAL
LOW DENSITY RESIDENTIAL-
Application
Application valuation:
0
Applicant: Architect or
TAtyl
f�'.GitiGv
BUILDING & SAFETY DEPARTMENT "
BUILDING PERMIT
SEP .2 61005
CIFla.y®r T -��t �I
� 1 ®I IfA`.�
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 Code, and my License is in full force and effect.:
License Class: A -B Li c No.: 690645
Dai te' Oi Cont�`i'��
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).:
( 1 1; 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.).
(_ 1 I, 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 doesnot apply to an owner of
,y
. property who builds or improves thereon, and who contracts for the projects with -a contractor(sl licensed
pursuant to the Contractors' State License Law.).
( . 1 I am exempt under Sec. , B.&P.C. for this reason
5 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: -
• 1
LQPERMIT
Owner:
R J T HOMES
1425 E'UNIVERSITY DR
PHOENIX, AZ 85034
Contactor:
RJT HOMES LLC
1425 E. UNIVERSITY DRIVE
PHOENIX, AZ 85034
(760)123-4567 "
Lic: No.: 690645
VOICE (760) 377=7012
FAX (760) 777-7011
INSPECTIONS (760)777-7153
Date:- 9/26/05
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 the work for which this permit is
issued. '
I 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
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 1583906
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.work rs' compensation provisions of Section
� 3700 of the Labor Code, I shall forthwi l o I ti those provisions. V
tDate_ (Applicant:— -
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 ($100,0001. 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 Director of Building and Safety for a permit subject 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 permit issued as a result of this application,
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.
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 andstate 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 authorizerepresentatives
of this county too enter upon the above-mentioned property for ins . r ores.
f0ater-7/.2ri' JSig_ature_(Applicant-or-Agent):
Application Number .05-00004285
Permit . . . . . .DEMO PERMIT
-
Y Additional desc
Permit. Fee 45.00
Plan Check Fee
.00
Issue Date
Valuation
0
Expiration Date 3/25/06
Qty, Unit Charge Per
Extension
BASE FEE
45.00
--------------------- ----.------------------------------------
Notes -and Comments
DEMO OF EXISTING BRIDGE(ORIGINALLY
PERMITTED Q 7.9-700 AVE 50/JEFFERSON).
Fee'summary Charged Paid
Credited
Due
Permit Fee Total 45.00
.00 .00
45.00
- Plan Check Total .00
.00 .00
.00
Grand Total 45.00
.00 .00
45.00
CITY OF LA QUINTA - PUBLIC WORKS/EN GINEERING DEPARTMENT
GREEN SHEET (PUBLIC WORKS CLEARANCE) FOR BUILDING PERMITS
Form updated S effective 8!25/2005
Please DO NOT submit the Green Sheet (Public Works, Clearance) Packet to the Public
Works/Enginee'ring Department until ALL requirements' listed below are complete. ;.,Incomplete'"'
6
applications or applications which cannot be processed will be returned to Applicant. Green Sheet
approvals'will be forwarded to the Building Department directly by Public Works. ; SEP 1 9 2005
Date: 09/19/05 Developer.. LLC tA_.
Tract No.: 29858 ' Tract.Name:
Address(s): 79-700 Ave 50 SVA
'almilla Lot No,(s): Mc
orner Ave 50 and Jefferson
D6E
&/V,
The following are the requirements for Public Works Clearance to authorize issuance of a building
permit from the Building/Safety Department.
CUSTOM HOMES:.PROVIDE::ITEMS #2, #3, #4 AND #5 BELOW.
TRACT IIOM.M .PROVIDE ITEMS #1,#2, #3, #4 (AS APPLICABLE) AND 06 BELOW.
COMMIERCIAL BUILDINGS/OTHER: PROVIDE ITEMS #:1, #2, #3 AND #5'BELOW.
I:. Attach ,Pad Elevation Certificates in compliance with the approved design elevation_ for
building pad (maximum allowable deviation of +/- 0.1 foot). Pad Elevation Certificates must
be current (within 6 months of current .date). if a precise grading plancreates the pad for
approval, please withhold green sheet submittal until a Pad Elevation. Certificate can be
provided.
2. Attach geotechnical'certiffcation of grading plan compliance.
3. Attach recorded ,final map. showing,proposed building locations.are legal lots.
�;�tlAttac 1 a completed <1 acre .per lot or infill project Fugitive Dust Control project information
form, PMIO plan &, agreement or provide alternative, & valid City approved PM40 plan set
-reference number or Hardcopy plan.. PMI0 plans ,for commercial and residential developments
(be, i_ !ot)' are submitted. se!:�arately avith grading plans and are subient to, adcii:ional
requirements: -
. y ,r
5 rAttach an approved precise grading plan for the building location(s). AO flood zone
developments will require an approved flood plain development plan.
6 Attach:an approved rough'grading plan for the building location(s).
I have reviewed and confinned the requirements listed above as presented and find the improvements
to be sufficiently complete, for construction of the proposed buildings)/structure(s). on the subject
lot(s). Pursuant t - dings the abov roject• released for building permit issuance.
Recommeridedb�: Dated: L O
Declined for approval for reason(s) as follow(s), please correct and resubmit:
T;1P\vDEPT\STAFF\Crob1:�Com%4n PW Retc i6 50SNGREEN SHEET COM -ax
Bin #
City of La Quinta
9pAV" ( Building 8z Safety Division
P.O. Box 1504 78-495 Calle Tampico
� '� P
La Quinta, CA 92253 - (760) 777-70.12
�� QUilding Permit Application and Tracking Sheet
.Permit �
�/
.7 ?Oo /�"
Project Address: Palmilla Tradt.29858-1 2
Owner'sNamc: RJT Homes-Palmilla LLC
A. P. Number.
Address:
Legal Description: Model Homes
City. ST, Zip: r¢
Contractor: . RJT Investments Inc.
Address:
Telephone:
Project Description:
City. ST, Zip:
Removal of existing temporary pedestroan
Telephone:
bridge at model complex.
State Lie. 11 : 690645
City Lie. 9: 04990
Arch., L•ngr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. 4:
N:une of Contact Person: Chad Meyer
Construction Type: occupancy:
Project type (circle on6): Nov Add'n Altcr Repair Derno
Sq. Ft.: # Stories: k Units:
Telephone a of Contact Person: 760 559-4031
Estimated value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
!
Submittal
Req'd
Recd
TRACKING
"ElMrr FEES
Plan Sets
Ilan Check submitted
Item
Amount
Structural Coles.
Reviewed, ready for corrections
. Plan Check Dc-)osil
Truss Cates.
Called Contact Person
Plan Check Ila,ance
Energy Calcs.
flans picked up
Construction
Flood plain plan
flans resubmitted
Mechanical
Grading plan
2" Review. ready for con-eclionslssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed .
flans picked up
S.M.I.
II.O.A. Approval
flans resubmitted
Grading
IN IIOUSE:-
Review, ready fur corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. %Vks. Appr
Datcof permil issue
School Fees
'total Permit Fees