04-7892 (BLCK)T4ht 4
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: 12/20/04
Application Number: 04-00007892 Owner:
Property Address: 286 ALOE CIR SHEA LA QUINTA
APN: 764-270-999-176 -300233- C/O JEFF MCQUEEN
Application description: WALL/FENCE 8800 N GAINEY CENTER 350
Property Zoning: MEDIUM HIGH DENSITY RES SCOTTSDALE, AZ 85258
Application valuation: 5823
Contractor: 'J A
Applicant: Architect or Engineer: SHEA HOMES, INC.
81260 AVENUE 62 DEC 2 ✓ 2�U4
LA QUINTA, CA 92253 7
�) ,^ (760) 777-6005 CITYOFII,q _
Lic. No.: 672285 FINANCE PT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section7 001 o Division 3 of the Susi sand Professionals Code, and my License is in full force and effect.
License CI ce se No.: 672285
ate ntractor:
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.).
(_) 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.).
( ) I am exempt under Sec. , B.&P.C. for this reason
/> Date:
//,,,/ 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.).
Owner:
Lender's Name:
Lender's Address:
LQPERMIT
1111111
VIII
III
VIII
IIII 63
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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 NTL UNION INS Policy Number 36568
_ I certify that, in the performan a of the work for whi his permit is issued, I shall not employ any
person in any manner so a o b ame subject to workers' compensation laws of California,
and agree that, if I should b ome ubjact to the __kers' compensation provisions of Section
700 of the Labor Code, all fo hwi[h c I e p
:�a plicaFAILURE TO SECURE PIKERS' 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.
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 wo is not commenced
within 180 days from date of issuancAave
r cessation of wo for 180 days will subject
permit to cancellation.
I ce ify t at I hav read this application and state tthemation is car . I agree to comply with all
cinancesand state laws relating tction, a er y authorize representatives
t Pon th bove-mentioned ption purposes
t ignature (Applicant or Agentl
Application Number . . . . . 04-00007892
Permit . . . . . . WALL/FENCE
PERMIT
Additional desc . .
Permit Fee . . . . 81.00
Plan Check
Fee
00
Issue Date . . . .
Valuation
5823
Qty Unit Charge Per.
Extension
BASE
FEE
45.00
4.00 9.0000 THOU BLDG
----------------------------------------------------------------------------
2,001-25,000
36.00
Special Notes and Comments
183 L.F. 6' GARDEN & 78 L.F. 3'
RETAINING WALL, BOTH ORCO SYSTEM
Fee summary Charged
-----------------
Paid Credited
Due
--------------------
Permit Fee Total 81.00
----------
.00
------
.00
- ---
81.00•
Plan Check Total .00
.00
.00
.00
Grand Total 81.00
.00
.00
81.00
LQPERMIT