BLCK (05-5217)61025 Living Stone Dr
05-5217
Application description:
Property Zoning:
Application valuation:
Applicant:
05-00005217r
6170"2"5_LIVING STONE DR
764-270-999-42 300234
WALL/FENCE
MEDIUM HIGH DENSITY RES
2870
Architect or
PIP
TAt!t,4 44.Q
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS 4760) 777-7153
Date: 11/29/05
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
License Cla s: B
%1}.1�J��
License No.: 672285
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
ntractor: ► J
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 AMERICAN HOME Policy Number 1247619
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 o as to become su ct 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 s Id me bje o the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Codel or
700 of the L°r sh I fort vii 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
l
/ /
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars IS5001.:
11
Dat . L/ !�
�pplic
(_ ) 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
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 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.).
1 _ I 1 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: I Ilk
LQPERMIT
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 (S100,000). 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 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.
certify that I have read this application and state A the above inform on is correct. I agree to comply with all
city and count ordinances and state laws relatin it ' g con on, and hereby authorize representatives
of this co my t upon the above-mentione pr pe for inspec n es.
Rilte:, ure (Applicant or ent): •�
Application Number 05-00005217
Permit WALL/FENCE PERMIT,
Additional'desc .
Permit Fee 54.00
Plan Check
Fee
.00
Issue,Date
Valuation
. . .
. 2870
Expiration Date 5/28/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0000 THOU BLDG 2,001-25,000
9.00
--------------------------------
Special Notes and Comments,
70 L.F. 6' GARDEN WALL, 70 L.F. 3'
RETAINING WALL, BOTH-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