BLCK (07-2015)P.O. BOX 1504. l
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN.
Application description
Property Zoning:
Application valuation:
Applicant:
11'07-000'02015
61805 MESA CT
764-280-999-59 -300237-
WALL/FENCE
MEDIUM HIGH DENSITY RES
2000
Architect or Engineer:
F.
V 'f
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner-
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER`350
SCOTTSDALE, AZ 85258 f
Contractor:
SHEA HOMES, INC.
60800 TRILOGY PARKWAY
LA QUINTA, CA 92253
(760)777-6005
Lic. No.: 672285
�4
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
.Date: 7/10/07,
LQPERi1IIT
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 '
Licens
Class: B., License No.: 672285
_"
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
,d�: l v� ntractor.V' `- - + -
/
I have and will maintain workers' compensation insurance, as required by Section 3700 of the. Labor -
Code, for the performance ofthe 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
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 workers' compensation provisions of Section -
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor );Rall forthwith amply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031 .5 by
V1 -
any applicant for a permit subjects the applicant to a civil penalty of not more than'five hundred dollars ($500).:
e:
,/►`
pplicant:
("_ I I, 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 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
- .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,
I—) 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 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. � ` s
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 the above information is correct.' I agree to comply with all
• work for which this permit is issued (Sec. 3097, Civ. C.1.
nd co
ty ordinances and state laws relating wlding constr tion, and hereby authorize representatives
.
-011fnM
enter upon the above-mentioned ro er yptp purposes.
Lender's Name: -
nature (Applicant or Agent): - ++
Lender's Address:
�Xe:
- - 7-
LQPERi1IIT
Application Number 07-00002015
'Permit . ... WALL/FENCE PERMIT
Additional desc .
Permit Fee 45.00 Plan Check
Fee'..
.00
" Issue Date . . . . Valuation
2000,
Expiration Date 1/06/08
Qty Unit Charge Per.
Extension
BASE FEE
15.00
15.00 2.0000.HND BLDG 501-2,000
30.00
-----------------------
Special Notes and Comments
-------
------ - - - - -- -
80 L.F 6- GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid Credited
Due
Permit Fee Total 45.00 .00
..00
45.00
Plan Check Total .00 .00
.00
00
Grand Total 45.00 .00
.00
45.00