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05-0941 (BLCK)T4hf 4 4 a" BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE TAM.PICO FAX (760)777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 umber . . . 'ess . . . APN: Application description Property Zoning . . . . . Application valuation . . BUILDING PERMIT Owner ------------------------ R J T HOMES 1425 E UNIVERSITY DR PHOENIX AZ 85034 0 5 = _0 0-0.0.0.9 4_l Date 3/17/05 50095 -VIA PUENTE 772-370-009- - - WALL/FENCE LOW DENSITY RESIDENTIAL 3625 Contractor ------------------------ RJT HOMES LLC 1425 E. UNIVERSITY DRIVE PHOENIX AZ 85034 Fee summary ----------------- Permit Fee Total Plan Check Total Grand Total Charged Paid ---------- ---------- 63.00 .00 .00 .00 63.00 .00 Credited. Due ---------- ---------- .00 63.00 .00 .00 .00 63.00 WCC: STATE FUND WC: 1583906 10/01/05- CSLB: 690645 06/30%06 CCC: A -B ---------------------------------------------------------------------------- Permit . . . . . . WALL/FENCE PERMIT Additional desc Permit Fee . . . . 63.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 3625 Expiration Date 9/17/05 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 145 L.F. 6' GARDEN WALL, ORCO SYSTEM Fee summary ----------------- Permit Fee Total Plan Check Total Grand Total Charged Paid ---------- ---------- 63.00 .00 .00 .00 63.00 .00 Credited. Due ---------- ---------- .00 63.00 .00 .00 .00 63.00 P.O. BOX 1504 • ���� 78-495 CALLS TAntelCo VOICE (760) 777-7012 LA QUII;TA, CALIFORNIA 92253 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: O:5'— Date:... 3 2 2 o S Applicant: Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.: t9uIL.UINta VtKMIT DECLARATIONS aA 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 de, and my License is in full force and effect. License Class License No. atentt rS actor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' Slate 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 (5500).): 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 -builder 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 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.). L) I am exempt under Sec. . BA P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I herebv 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 insur mer and policy number are: arrier icy Number I certify that, in the performance f the work for which this permit is issued. 1 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. Date ,plicant 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 I hereby affirm under penalty of perjury that there is a construction lending agency forJthe peAGENCY performance of he 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 of Building and Safety for a rmit ohe 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 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 representatives of this county to enter upon the above-mentioned property for inspection purposes. Date gnature (Applicant or Agent):