06-2630 (ELEC) celly/ 4 4, add 1111
P.O. BOX 1504 VOICE 760 777-7012
78-495 CALLE TAMPICO FAX(760)777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING&SAFETY DEPARTMENT INSPECTIONS (760)777-7153
BUILDING PERMIT
Date: 7/11/06
Application Number: 06-00002630 Owner:
Property Address: 52459 HAWTHORN CT RJT HOMES - CODORNIZ
APN: 772-10 -997-77 -32070 - P.O. BOX 810 _
Application description: ELECTRICAL LA QUINTA, CA 92253 '
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 2400
I A .
Contractor: 104 i __, ji
Applicant: Architect or Engineer: RJT INVESTMENTS INC • ��
• 1425 E. UNIVERSITY DRIV CO)„. 0
PHOENIX, AZ 85034 Fk �
(602)257 1656 aoiii-
at-fd'i'-d'6it � ` /N Lic. No. : 690645
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 I hereby affirm under penalty of perjury one of the following declarations:
Section 7000)of Division 3 of the Business aryl 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 iss: -B J/� icense No.: 690645 far by Section 3700 of the Labor Code,for the performance of the work for which this permit is
L r3 //r issued.
"� Dots: 1d ontrector: ] f �I haveandwill maintainworkers'compensation insurance,as requiredby Section3700 oftheLabor Cade,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 0460014793
following reason(Sec.7031.5,Business 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,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 700 of the tabor Code,I s I hwith co ly with those provisions.
that hep oli shen is a exempt therefrom subjects
and the basisfor the alleged of notion. Any violationv of Sectiond70350 by �
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 155001.: •.,. � i ••• cant:
( I 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 WARM G: FA( RE 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($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 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,
(_1 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 c. n ..[dingoes and st aws relating to building construction,and hereby authorize representatives
of this c., u .en -r upon t ave-mentioned property fo inspection purposes.
Lender's Name:
Lender's Address: \�
■•e: /( 0 f - mime(Applicant or Agent): _ `-� -Yel../7
LQPERMIT
Application Number 06-00002630
Permit ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . 33.50 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . . 1/07/07
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 18.5000 EA ELEC SVC <=600V/<=200A 18.50
Special Notes and Comments
100 AMP SINGLE PHASE LANDSCAPE METER
Fee summary Charged Paid Credited Due
Permit Fee Total 33.50 .00 .00 33 .50
Plan Check Total .00 .00 .00 .00
Grand Total 33.50 .00 .00 33 .50
LQPERMIT