08-1334 (RER)P.O. BOX 1504 ^'
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 08-00001334-77
Property Address: 81454 RUSTIC CANYON DR
APN: 764-280-999=.166 -300236-
Application description: REMODEL - RESIDENTIAL
Property. Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 16141
Applicant: Architect or Engineer:
l
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350
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: 8/06/08
i lJ-L�
�D
AIN 12 2008
1 1008
CITY OF LA QUINTA
FINANCE DEPT.
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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: '
Section 7
00) of Division 3 of the 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
Li
ns
ss: License No.: 672285
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
e:4KZ
ontractor: •
issued.
Ix 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 NTL UNION INS Policy Number WC1894819
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 m any manner so as to become subject to the workers' compensation laws of California, ,
permit to fife a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State -J,*a
agree that, if I should become bject -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
0 f the La or I hall fe with 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
*any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
licant-. _
(_) 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 W KERS' 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 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 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:
'Lender's Address:
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 that the above inf ation is correct. I agree to comply with all
city and ounty rdinances and state laws relating to 'Iding constr ion and hereby authorize representatives
of INt e r pan the ve-mentioned pr p [y fo n rposes.
e: I ure (Applicant or Agent). I
LQPEPA11T
Application Number . . . . . 08-00001334
Permit BUILDING PERMIT
Additional desc .
Permit Fee 180.00 Plan Check Fee
117.00
Issue Date . . . Valuation . . .
. 16141
Expiration Date 2/02/09
Qty Unit Charge Per.
Extension
BASE FEE
45.00
15.00 910000 THOU BLDG 2,Q01-25,000
----------------------------------------------------------------------------
135.00
Permit. . . SOLAR PERMIT
Additional desc .
Permit Fee . . . . 22.50 Plan Check Fee
5.63
Issue Date . . . . Valuation . . .
. 16141
Expiration Date 2/02/09
Qty Unit Charge. Per
Extension
BASE FEE
15.00
1.00 4.5000 EA SOLAR COLLECTOR < 1000
4.50
1.00 3.0000 EA SOLAR EQUIP MISCELLANEOUS
3.00
Special Notes and Comments
REVISION WHILE UNDER CONSTRUCTION -
INSTALL PHOTOVOLTAIC SYSTEM 1.3C - 5KW.
PLAN 4215C.
------------------------------------=------7--------------------------------
Other Fees . . . . . . ENERGY REVIEW FEE
11.70
Fee summary Charged Paid Credited
Due
Permit Fee Total 202.50 .00 .00
202.50
Plan Check Total 122.63 .00 .00
122.63
Other Fee Total 11.70 .00 .00
11.70
Grand Total 336.83 .00 .00
336.83
LQPEPA11T