08-0214 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA' QUINTA, CALIFORNIA 92253
Application Number:
08-00000214
Property Address:
c 81457—MOONSTONE CT
APN:
764 -280 -999 -105 -300236 -
Application description:
WALL/FENCE -
Property Zoning:
MEDIUM HIGH DENSITY RES
- Application valuation:
3000
T-iht 4 4 Q",
BUILDING & SAFETY'DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN'
8800 N GAINEY CENTER 350
SCOTTSDALE, AZ 85258
4 '
o
Contractor:
,
F�
9n EA HOMES, INC.
cpry0/� 0�`�Ot� . B00 TRILOGY AY
QUINTA, CA 92253
A
(76,0) 777-6005 .
is Lic. No.: 672285
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LICENSED CONTRACTOR'S DECLARATION
I hereby firm nder penalty of p y that I am I'ce ed under provisions of Chapter 9 (commencing with -
Secti 7 00) o Division 3 of th 'ness and P ofe sionals Code, and my license is in full force and effect.
.Lic se 1 s License No.: 672285
a
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
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
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).:
(_ 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
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
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 or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( ) I am exempt under Sec. , BAP.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:
Lender's Address: -
I,QPERD1IT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/30/08
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WORKER'S COMPENSATION DECLARATION
I herebyaffirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided -
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
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
insurance carrier and policy number are:
Carrier AMERICAN HOME Policy Number C 1593364 i
I certify that, in the perf a of the work for whit tl is permit is issued, I shall not employ any
person in anyfflCod
s t beco ubject to t e orkers' compensation laws of California,
and agree thac me je t to the -v r ers' compensation provisions of Section
( _ �QO of the s Ifo it c ply f t>, ho6e provisions.
e: ���/] �X} pplice
(�
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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 Ouinta, 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 ap :cation becomes null and void if work is not commenced
within 180 days from date of issuanc f such permit, or cessation of wor for 180 days will subject
permi to cancellation.
I certify th I hav read this application and sta a e abo a in o ation is correc . agree to comply with all
city d cc ty or inances and state laws reta ng to uil iQg onst cti n, and h reb thorize representatives
of un y to9e ter upon the above-mentio d pr party f r insp do pu pos S.
!�
D ature (Applicant tl:
Application Number . - . . . 08-00000214
Permit . . . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 54.00 Plan Check Fee 00 .
Issue Date . . - Valuation . . . ..3000
Expiration Date.. 7/28/08
Qty Unit Charge Per Extension
BASE FEE 45.00
1.00 9.0000 THOU BLDG 2,001-25,000 9.00.'
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Special Notes and Comments
120 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 .00 .00 .00 .00
Grand Total 54.00 .00 .00 54:00
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