BLCK (06-2075)t
P.O. BOX 1504
78-4.95 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
06-00002075.
61691 MONROE
764-280-999-13
WALL/FENCE
MEDIUM HIGH
1750
ST
-300235-
4 e4aQW4w - "
BUILDING .& SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN .
8800 N GAINEY CENTER 350
SCOTTSDALE, AZ 85258
Contractor:
SHEA HOMES, INC.
81260 AVENUE 62
LA QUINTA, CA 92253
'. (760)777-6005
Lic. No.: 672285
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/18/06
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 Icommencing 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
License Cl s: Licensee No.: 672285
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
/ s�
Date: tractor:
/. DO M F,S �
issued.
�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
- 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
700 of th abor Code, I shall forthwith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
It
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).:
ate: o pplicant:c7'.1L
(_) 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.).
(_) I, 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 of improves thereon, and who contracts for the projects with a contractors) licensed
pursuant to the Contractors' State License Law.).
(_ 1 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: 1,
Lender's Address: AJ
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 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.
I certify that I have read this application and state thatthe above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authori sentatives
of this cp" 0ou/pty t enter upon the above-mentioned property for inspection purposes.
06 -Ie: `�i�i ture (Applicant or Agent).
l
Application Number• , . . . . 06-00002075
Permit . . . .: WALL/FENCE PERMIT
Additional desc
Permit Fee 41.00 Plan Check Fee .00
Issue. Date Valuation 1750
Expiration Date 11/14/06
Qty Unit Charge Per Extension
SASE FEE 15..00
A®
l
Application Number• , . . . . 06-00002075
Permit . . . .: WALL/FENCE PERMIT
Additional desc
Permit Fee 41.00 Plan Check Fee .00
Issue. Date Valuation 1750
Expiration Date 11/14/06
Qty Unit Charge Per Extension
SASE FEE 15..00
Bin #
city of La Quinta
Building &r Safety DMston
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012'
Building Permit Application and Tracking Sheet
Permit #
Project Address:
Owner's Name: Sl-(gA H01,06S
A. P. Number:
Address: &0-800
Legal Description: 4QUlrsXrpq
City, ST, Zip: M L9LA41VTPJ1 e0q.
Contractor: St4fA
Telephone: -7& -7 -7 7 610.3
F,
Address: (PO —go 0 7_7Z4L,0&LJ 71WY-1vi4y
Project Description:
City, ST, Zip: Ql,l t rxM
Telephone: 7&0 -n 7 - to OEM=
State Lic. # :ti 4D9 34 City Lie. #..
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
�x
onstruction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: __3t4�
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: Z-7 2 9-798
lEstimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
4
Submittal
Req'd
Rec!d
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
21' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees