07-0476 (BLCK)c.,
---al
R,.
P.O. BOX 1504
-
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
I hereby affirm under penalty of perjury one of the following declarations:
Appli6ationNumber:
/_07-00000476
Property Address:
81685 RUSTIC CANYON DR
APN:
764-280-999-35 -300237-
Application description:
WALL/FENCE
Property Zoning:.
MEDIUM. HIGH DENSITY RES
Application valuation:
3085
Applicant:
vt
Architect or Engineer:
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.
60800 TRILOGY PARKWAY
LA QUINTA, CA 92253
11(760)777-6005
lic. No.: 672285
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/13/07
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LICENSED CONTRACTOR'S DECLARATION
-
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WORKER'S COMPENSATION DECLARATION
- I here affir 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:
- Se'ti 700 1 of Division 3 of the Busines Profess* o I Code, and my license is in full force and effect.
C ense No.: 672285
_ 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
a ractor:
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
_
become subject to the workers' compensation laws of California,
p rson in any manner sqdb
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
d agree that, if I shoorae ect tot workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
of the r Cll rt'.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 apermit subjects the applicant to a civil penalty of not more than five hundred dollars ($5001:
ate: plica
[ _ 1 1, 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 ISec. 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 ISec:
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.). .
1 ' 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:
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 actor 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
ermit to cancellation.
I certify tha I have ead this application and state that th ve informat4and
rrect. I agree to comply with all
city a my or finances and state laws relating to b dingiconst i nand
authorize representatives
of n ter upon the above-mentioned to for in a i .
te: Si ture (Applicant or Agent):
Application Number . . . . 07-00000476
Permit . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee 63.00
Plan Check Fee
.00
Issue Date
Valuation. . . .
. 3085
Expiration Date 8/12/07
Qty Unit Charge Per
Extension
BASE
FEE
45.00
2.00 9 .0000 THOU BLDG
2, 001.-25 , 000
1R.00 ,
Special" Notes and Comments
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85 L.F. 6' GARDEN WALL, 60 L.F.
4' 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