04-7894 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
04-00007894
Property Address:
APN:
764-270-999-174 -300233-
Application description:
WALL/FENCE
Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
8500
Tiht 4 4 Q"
Applicant: Architect or Engineer:
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LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70 0) o 'vision 3 of theBo ess and Professionals Code, and my License is in full force and effect.
Licenla License No.: 672285
Date: Con ract
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 ISec. 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 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, BusinessandProfessions 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 _ 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 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:
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:
LQPERIIIIT
IIIIIIIIVIII IIIVIII(III 80 I
—
IE
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350
SCOTTSDALE, AZ 85258
VOICE (760) 777-7012
FAX (760) 777-7011 .
INSPECTIONS (760) 777-7153
Date: 12/20/04
DContractor:
SHEA HOMES, INC.
81260 AVENUE 62 UEC 231004
LA QUINTA, CA 92253
(760) 777-6005 CITY OFI
Lic. No.: 672285 ptu�QUINTA I
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WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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 req ed by Section 3700 of the Labor
Code, for the performance of the work for which this permit My workers' compensation
insurance carrier and policy number are:
Carrier NTL UNION INS Policy Number 6436 6
_
-I �agr.e
eifthat, in the performance the work for which thi it is issued, I shall not employ any
n in any manner so as to b subject to the ers' co ion laws of California,
that, if I should beco sub) ct tot rs' pensation provisi coon
�bfi[fnLabor Code, I ort i comply w' ose provisions.
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.
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 t e work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application bec mas null and vo�Aee
of commenced
within 180 days from date of issuance of such per it, or cessation 80 days will subject
permit to cancellation.
I certify t t I have read this application and state that the ab i ation is c to comply with all
city and c unty or inances and state laws relating to buildi c uc on, and hereby a h r�tives
off t s c y ter upon the above-mentioned prope y r' spe ti nposes.
Uate. Signature (Applicant or Agent):
Application Number . . . . . 04-00007894
Permit WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . . 108.00
Plan Check
Fee
00
Issue Date . . . .
Valuation
. . .
. 8500
Qty Unit Charge Per
Extension
BASE
FEE
45.00
7.00 9.0000 THOU BLDG
----------------------------------------------------------------------------
2,001-25,000
63.00
Special Notes and Comments
340 L.F. 6' GARDEN WALL, ORCO SYSTEM
Fee summary Charged
-----------------
Paid
Credited
Due
--------------------
Permit Fee Total 108.00
----------
.00
----------
.00
108.00
Plan Check Total .00
.00
.00
.00
Grand Total 108.00
.00
.00
108.00
LQPERMIT