BLCK (09-0452)61338 Living Stone Dr
09-0452
• Date: 5/11/09
Application Number: 09-00000452"' Owner:
Property Address: 6133,8 LIVING STONE DR SHEA LA QUINTA
APN:. 764=280-999-194 -30.0236- C/O JEFF MCQUEEN
Application description: WALL/FENCE 8800 N GA'INEY CENTER
Property Zoning: MEDIUM HIGH DENSITY RES SCOTTSDALE, AZ 85258 D ^
Application valuation: 2125 Q Q
Contractor: I n
Applicant: Architect or Engineer: SHEA HOMES, INC.
60800 TRILOGY PARKW Y 1 U ff
LA QUINTA, CA 9225 C%TY
!.?r p
(760) 777-6005
r7 `.yT
Lic. No.: 672285
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affir 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 000 of Division 3 of the Busi ess 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 lass: License No.: 672285 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
AJissued.
�a ontractor: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. WC1894619
following reason (Sec. 703-1.5, 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 should become subject to the wor ' comp sation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3� of the Labor e, I sh 1 fo' hwith comp) with th s r Bions. _
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 (5500).: licant:
( ) 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 KERS' 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.).
(_) 1, 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.).
(_) I 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:
LQPERMIT
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 workisnot 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 ad co my ordinances and state laws relating to building constr ction, and hereby thori,e relatives
pf thi cOu y to enter upon the above-mentioned prop for inspe ion urposes.
pr en
I��.aIEl Si ure (Applicant or Agent):
LQPERMIT
Application Number . . . . . 09-00000452 .
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 54.00
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 2125
Expiration Date 11/07/09
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
85 L.F. COMBO WALL, 3' RETAINING, 6'
GARDEN, ORCO SYSTEM.
Other Fees . . . BLDG STDS ADMIN (SB1473)
1.100
Fee summary Charged Paid
Credited
Due
Permit Fee Total. 54.00
00- .00
54.0:0
Plan Check Total .00
.00 .00
-.00
Other Fee Total 1.00
.00 .00
1.00 -
Grand Total 55.0.0
.00 .00
55.00