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BLCK (05-5222)Application Number: 05-00005222 Property Address: 61125 Living Stone Dr 05-5222 OWNER: SHEA LA QUINTA APN: 764-270-999-47 --300234- C/O JEFF MCQUEEN Application description: WALL/FENCE �. 8800-,N GAINEY CENTER 350 Property Zoning: MEDIUM HIGH DENSITY RESSCOTTSDALE, AZ.,85258 Application valuation: 2255 T- DZ��n 11 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/29/05 C ctor: Applicant: Architect or Engineer.LF C 1 2��5 HOMES, INC. 0 AVENUE 62 OF UINTA, 'CA 92253 y,� ®g1ifi/a (7 0) 777-6005 �{ p% Le Let Li No.: 672285 _ 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 CI ss: License No.: 672285 - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ate Vs ntractor: 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 Carriei 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 beco subject to the workers' compensation laws of California, permit to file a signed statement that fie or she is licensed pursuant to: the provisions of the Contractor's State and agree that, if should become s ject to the workers' compensation provisions of Section License Law (Chapter 9 Icommencing with Section 7000)of Division 3 of the Business and Professions Code) or 3700 of the Labo I shall for ith 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).: at `v ica 1 _ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work` and .000 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 I, as owner of the property, am exclusivelycontracting 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, 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 above inform tion is correct. I agree to comply with all work for whichthis permit is issued (Sec. 3097, Civ. C.)..- �� - city and county ordinances and state lawsrelating to b ' i construc o and hereby authorize representatives of this coun y to eater upon the above-mentioned pe y r ins p poses. - Lender's Name: - _ • - ate: `L•• .���,'�'ature (Applicant or Ag - Lender's Address: - LOPERMIT Application Number . . . . . 05-00005222 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 9.00 ------------------------------------------------------------ Special Notes and Comments. --------------- 55 L.F. 6' GARDEN -WALL, 55 L.F. 3' RETAINING WALL, .BOTH•ORCO SYSTEM 1 Fee summary Charged Paid - Credited Due Permit Fee Total 54.00 ----- .00 ---------- .00' 54.00 - Plan Check Total .00 .00 .00 .00 Grand Total 54.0.0 .00 .00 54.00 r LQPERMIT