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BLCK (05-2111)61010 Living Stone Dr 05-2111 Application Number:05-00.0.0.21-1:1 Property Address: APN: 61010 LIVING STONE DR Application description: 764-270-999-109 -300234- Property Zoning: WALL/FENCE Application valuation: MEDIUM HIG BUILDING &SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/31/05 Owner: --------------------------------- pSHEA LA QUINTA C/O JEFF MCQUEEN- 8800 N GAINEY CENTER 350 0 F3 2005 �QUINTA LA Contractor. Applicant: Architect or Engineer. L�f___________________________,____ SHEA 'HOMES, INC. 81260 AVENUE 62 1) /� LA QUINTA, CA 92253 Lic. No.: 6436568 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 License class: 672285 "Cense No.: 6436568 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is �oa�'e/pissued. 01 ontractor: 41 1 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 6005 Policy Number NTL UNION INS 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 iss ric 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 prow\• ons of the Contractor's State and agree that, if 1 should become subject to the workers' compensation provisions of Section i License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Miness and Professions Code).or /' 3700 of the Labor Code, I sh I forthwith co ly with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any _ olation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more.th, ive hundred dollars ($500).: ate// �i7 6 pplicant: - 1 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and ` �1 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 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 orherself 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, amexclusively 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 a9 ents and employees for any act or omission related to the work being 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: 1 Lender's Address: ►J LQPERMrT . 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 ordinancesantate laws relating to building construction, and hereby au h Irize representatives ofthis cou ty toe ter up the above-mentioned property for i cti purpos D�te� ignature (Applicant or Agent): Application Number. 05-00002111 Permit .-WALL/FENCE PERMIT Additional desc ' Permit Fee �. 54.00 Plan Check Fee .. ,. _- .00 Issue.Date Valuation 2250 'Expiration Date 11/27/05 Qty Unit Charge Per Extension . BASE FEE 45.00 1.00 9.0000 THOU BLDG.2,001-25,000 9.00 - r------------------------------------------ Special Notes and Comments 90 L.F. 6- GARDEN WALL,ORCO SYSTEM ' Fee summary Charged Paid Credited Due ------ Permit Fee Total*` 54.00 ---------- .00 ----------- .00 54.00 Plan Check Total' .00 .00 .00 .00 Grand Total 54.00 .00 .00 54.00 LQPERMIT .. • - -