BLCK (07-2012)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253
-4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT '.
Owner:
SHEA LA QUINTA
:C/O JEFF MCQUEEN
+ 8800 N GAINEY CENTER
SCOTTSDALE, AZ 85258
Contractor:
h Applicant: Architect or Engineer:- SHEA HOMES, INC.
60800 TRILOGY PARKWA
VOICE (760)777-7012'
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/10/07
JUL 16 207 -
NAN LA QUINTq .
LA QUINTA, CA 92253-"�►'►.
Application Number:
07-00002012
.Property Address:
- 61765 MESA CT
APN:
764-280-999-57 -300237-
Application description:
WALL/FENCE _
Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
3240
-4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT '.
Owner:
SHEA LA QUINTA
:C/O JEFF MCQUEEN
+ 8800 N GAINEY CENTER
SCOTTSDALE, AZ 85258
Contractor:
h Applicant: Architect or Engineer:- SHEA HOMES, INC.
60800 TRILOGY PARKWA
VOICE (760)777-7012'
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/10/07
JUL 16 207 -
NAN LA QUINTq .
LQPERMPI`
LA QUINTA, CA 92253-"�►'►.
(760) 777-6005 -
Lic. No.: 672285
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.. .. 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:
S coon 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
Code, for the work for which this.permm is
i nse C ass: B �No.: 672285
�\ �
t/ \
for by Section 3700 of the Labor the performance of
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
ontracto
. 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 1
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
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
and agree that, ' hould become sub ect to the workers' compensation provisions of Section
13.700 of the La or de, ( ill fo h omply with those provisions.
ill
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
to of not more than five hundred dollars ($500).: •
' 1(
ate: '
any applicant for a permit subjects the applicant a civil penalty
(_) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure isnot 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 sate.). -'
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 whocontracts for the projects with a contractorls) 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 ,
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
permit to cancellation.. r '• `_^ ,:,
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.)'
• s
city rid coQmy ordinances and state laws relating to b firuction, d hereby authorize representatives .`
o�t ur v enter upon the above-mentioned pro �Yfgorc�, eFtio
—!1
Lender's Name: - -
-
!!
1" �4 '
te:' gnature (Applicant or Agent): -
Lender's Address:. N
- -
LQPERMPI`
M_FP
-
Application Number . . . . . 07-00002012
Permit . . . . . . WALL/FENCE PERMIT.
_
Additional desc .
Permit Fee 63.00 Plan Check
Fee
.00
Issue Date Valuation.
3240
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
120 L.F-. COMBO'WALL, 3' RETAINING, `6',
GARDEN & 15 L.F. 3' RETAINING WALL, ALL .
ORCO.SYSTEM
Fee summary Charged Paid Credited
Due'
7
Permit Fee Total - 63.00 Ob
7
.00
63.00
Plan Check Total .00 .00
.00
.00
Grand Total 63.00 .00
00
63.00
LPPERN11T _
-