BLCK (05-5220)61085 Living Stone Dr
05-5220
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
0-5-00005220
61085__LIVING—STONE DR
764-270-999-45 -300234-
WALL/FENCE
MEDIUM HIGH DENSITY RES
2255
Architect or Engine(
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 (760)' 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
en� Cl a s: B icense No.: 672285
_
for by Section 3700 of the Labor Code, for the performance of the work for. which this permit is
Date: ntractor: ~
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 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 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's State
and agree that, if I sh d b ome subj t 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
370 of the Labor h II forth h comply with those provisions.
that he or sheds exempt therefrom and the basis for the alleged, exemption. Any violation of Section 7031.5 by
f tt
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
at
licant:
(_ 1 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
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 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
1, 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,
(_) 1 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 ouinta, 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 days 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' correct. I agree to comply with all
' work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and state laws relating to building construction, hereby authorize representatives
of tco ty to ,nter upon the above-mentioned propertn pecti9 n p oses.
Lender's Name: �
� 1
- .Lender's Address:
nature (Applicant or Agent):
'
LQPERMIT -
-
Application.Number .". 05-00005220
Permit : WALL/FENCE
PERMIT
Additional desc .,
Permit Fee . . 54.00
Plan Check
Fee'.
.00
Issue Date
Valuation
2255
- Expiration Date. 5/28/06
Qty Unit Charge Per
Extension
BASE
FEE
45.00
1.00 9.0000 THOU BLDG
2,001.-25,000
9.100 _!
-----------------------------------------------------------------------------.
Special Notes and Comments
�- 55 L.F.',6' 'GARDEN WALL, 55 L.F.
3'
RETAINING WALL, BOTH ORCO SYSTEM
Fee summary Charged
Paid, 6Credited
Due
----------
Permit Fee Total 54.00
----------
40
----------
.00
54.00
-Plan Check Total .00
00
.00
.00
Grand Total 54.00
.00
.00
54.00
• LQPERMIT
r