BLCK (07-2018)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
07-00002018, Owner:
61750 MESA CT SHEA LA QUINTA
764-280-999=65 -300237-*,.C/O JEFF MCQUEEN .
WALL/FENCE 8800 N'GAINEY CENTER 350
MEDIUM-HIGH DENSITY RES SCOTTSDALE,AZ 85258 -
4000
Contractor:
Architect or Engineer: SHEA HOMES, INC.
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760).777-7153
Date: 7/10/07
60800 TRILOGY PAR
LA QUINTA, CA 922 3 JUL 1.6 2001
.1 (760)777-6005
Lic. No:: '672285 CITY OF
F/rygryC QUI 7A
• • - E gFPT
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 Clas B License No.: 672285
for by Section 3700 of the Labor Code, for the performance of.the work for which this permit is
.issued.
ate: ��� tractor: , v'` -T+ 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:
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 theworkers' 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 l should become subject 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 700 of theLabor ode, I shall forthwi h comply with those provisions.
.that he li she o exempt t subjects th d the basis for the alleged of notion. Any violation of ed dollars
7031.5 by '� .:,
any applicant for a permit subjects the applicant to a civil penalty'af not more than five hundred dollars ($5001; : Date: pptica' t: JJJLLL777 ��u _
(_ 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—) I, 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 witha 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 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 underpenalty 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 is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). *ate:
ppppppunty ordinances and state laws relating to building construction, and hereby authorize representatives
n_ to enter upone above-mentioned pr rty JqL inspect n purposes.
Lender's Name: VtIl�p�\e1 ignature (Applicant or Agentl:"" .,
Lender's Address:
LQPERMIT
Application Number . . . . 07-00002018
Permit . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . 63.00
Plan Check
Fee
.00
Issue Date . .
Valuation
. . .
. 4000
Expiration Date 1/06/08
Qty Unit Charge Per
Extension
BASE FEE
45.00
2.00 9.0000 THOU BLDG 2,001-25,000
18.00 -
- ------------------------
Special Notes and Comments
------------
-------
--------------
160 L.F 6' GARDEN WALL, ORCO SYSTEM
-
Fee'summary Charged Paid
.
----------------- - --- - - - - - - -
Credited
Due
- -
- - - - - - - -
Permit Fee Total 63.00
- - - - - - - - - -
.00 w.00
- - - . - -
- - - -.- -
j
63.00
Plan Check Total .00
.00
.00
..00
Grand Total- 63.00
00
.00
63.00
LQPERMIT -