BLCK (07-2008)` ;fes• `ryf� - .
P.O. BOX 1504
78-495 CALLE TAMPICO _
LA QUINTA, CALIFORNIA 92253
Application Number: l07-00002008
Property Address: 61790 MESA CT
APN: 764-280-999-63 -300237-
Application description:. WALL/FENCE
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 2625
Applicant: Architect or Engineer:
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N"GAINEY CENTER 35
SCOTTSDALE, "AZ 85258
Contractor:
SHEA HOMES, INC..
'60800.TRILOGY PARKWAY"
LA QUINTA, CA 92253
(760)777-6005
Lic. No.: 672285
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: . 7/10/07
' 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:
Sect n 700 of Division 3 of the Busi ess and Pro es ionals 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
i lass License No.: 672285
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
+ - -
- issued.
atentractor. -
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
in any manner so as. to become subject to the workers'. compensation laws •of California, -
R
• 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, if�out (come b ect to t workers' compensation provisions of Section
3700 of the Lalij � e/ I spall` th ith com with those provisions.
fy/
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).: -
6person
at plicant: "
(_) 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 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
1 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 the Contractors' State License Law.). -
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
-to
(_ ) 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
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 ISec. 3097, Civ. C.). `
Lender's Name:
Lender's Address: `
'LQPERMIT
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 work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
Wtheis application and state t e above information is correct. I agree to comply with all
s and state lawsrelating o buil g conction, and reby authorize representatives
n the above-mentioned rope for ins ion, pur osture (Applicant or Agent . I
Application Number ". 07-00002008
Permit . .. WALL/FENCE PERMIT .
Additional desc
Permit Fee . . 54.00 Plan Check
Fee
00
Issue Date. Valuation
.2625
Expiration Date 1/06/08
Qty Unit Charge Per
Extension
BASE FEE
45.00,
1.00 9.0000. THOU BLDG .2,0.01-25,000,
9.00
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Special Notes and Comments.
105 L.F. 6' GARDEN-WALL, ORCO SYSTEM
- Fee summary Charged Paid Credited
Due
Permit Fee Total 54.00 00
.00
54.00
Plan Check Total 0.0 00
00
..00.
Grand Total 54.00 - 00
.00
54.00
,QPERMIT
-