BLCK (05-1834)60915 Living Stone Dr
05-1834
Property Zoning:
Application valuation:
Applicant:
BUILDING & SAFETY DEPARTMENT
- BUILDING PERMIT
(77770-0-0 3-4-
60915
460915 LIVING STONE DR ,
764-270-999-32 -300234-
WALL/FENCE
MEDIUM HIGH DENSITY RES
3740
Architect or Engineer:
JUN 03 2005 ILO
CITY OF LA QUINTA
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350
SCOTTSDALE, AZ 85258
Contractor:
SHEA HOMES, INC:
81260 AVENUE 62
LA QUINTA, CA 92253
(760)777-6005
Lic.-No.: 672285
a
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760)777-7153
Date: 5/24/05
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 and 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
t
License Class: "B License No.: 672285
for bySection 3700 of the Labor Code, for the performance of the work for which this permit is
�Oate: W ontractor. �Q /'�/� v' -
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
• 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 NTL UNION INS Policy Number 6436568
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'sState
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
3700 of the Labor Code` I shall forthwith comply with those provisions.
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).:
ate: pplicant:
( ) 'l, 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
WARNING: FAILURE TO SECURE;WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
=7Contractors' 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
(_) 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,
( ) 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 day's 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 ISec. 3097, Civ. C.).
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 f inspection purpose
Lender's Name:
i
ate: .gnature (Applicant or Agentl: "
Lender's Address:
LQPMIIT
-
LQPERMIT
ti
Application Number 05-00001834
Permit . . . WALL/FENCE
PERMIT
Additional desc
Permit Fee 63.00
Plan Check Fee
001.
Issue Date . . . ..
Valuation
37.40
Expiration Date 11/20/05
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
140 L.F. 6- GARDEN WALL, 15 L.F.
3'
RETAINING WALL, BOTH ORCO SYSTEM
Fee summary Charged
Paid Credited
Due-
Permit Fee Total 63.00
.00 .00
63:00
Plan Check Total .00
.00 .00
.00
Grand Total 63.00
.00 .00
63.00
LQPERMIT
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