07-0475 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
074-00000475
81673 RUSTIC CANYON DR'
764-280-999-34 -300237
WALL/FENCE
MEDIUM HIGH DENSITY RES
3165
Architect or Engineer
BUILDING & SAFETY DEPARTMENT .
BUILDING PERMIT
M
FEB 2 0 2007
CIN OF LA QUINTA
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800,N GAINEY CENTER 350
SCOTTSDALE, A7 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: 2/13/07
---------------------=---------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby ffirm nder penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Ihereby affirm under penalty'of perjury one of the following declarations:
Sec ' n 0001 f Division 3 of the Busi
es 'and Professio als 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 a
License No.: 672285
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
ate: Tactor:
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:
1 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 a o become subject to the workers' compensation laws of California,
permit to file a signed statement that he or shA 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
d agree that, if I sho b he workers' compensation provisions of Section
A 700 of the Labor C I shwith those provisions.
that'he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
,?any OE�ply
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:te:
licant:
1 _ 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
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.).
(_ 1 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 contractors) licensed
pursuant to the Contractors' State License Law.).
(_ I 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: '
LQPERMIT i
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 isnot commenced
witNn 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation. '
I certify t t I h ve read this application and state that thea ve information is co ct. I agree to comply with all
city ount ordinances and state laws relating to bui ng onstr on, and eby authorize representatives
oftNL,
genter upon th above-mentioned pro tt i=s cti purpol Date:"` Si ature (Applicant or Agent):
Application Number . . . 07-00000475
Permit •WALL/FENCE PERMIT
Additional desc .
Permit Fee . . 63.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
3165
Expiration Date 8/12/07`
Qty Unit Charge Per
Extension
BASE
FEE
45.00
2.00 9.000:0 THOU BLDG
2.001.-25.000
18.00
- - -
Special Notes and Comments
- - --
-----
--------- - - - - --
85 L.F. GARDEN WALL, 65 L.F. KNEE
WALL,
BOTH ORCO SYSTEM
Fee summary, Charged
Paid Credited
Due
Permit Fee Total 63.00
.00
.00
63.00
Plan Check.Total 00
.00
.00
.00
Grand Total 63.00.
00'
.00
63.00