07-0469 (BLCK)Qum'
P.O. BOX 1504 ^' VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011.
LA QUINTA,. CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT- INSPECTIONS (760) 777-7153
BUILDING PERMIT
- - - Date: 2/13/07
Application Number: -07---0_0000469 — ; Owner:
Property Address: --81700-RUSTIC-CANYON DR SHEA LA QUINTA
APN: 764-280-999-131 -300237- C/O JEFF MCQUEEN
Application description: WALL/FENCE 8800 N GAINEY CENTER 350
Property Zpninp: MEDIUM HIGH DENSITY RES R(YITTATIAT,R, A7. RS?S,R
Application valuation: 3245
Contractor:.
Applicant: Architect or Engineer: ® SHEA HOMES, INC..
60800 TRILOGY.PARKWAY
LA QUINTA, CA 92253
FEB 20 2001 (760)777-6005
/ LiC. No.: 672285
CITU OFIN6►NC DgPiA-IIT �
LICENSED CONTRACTOR'S DECLARATION
I hereby airm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7 001 o Division 3 of the Business and Professionals Code, and my License is in full force and effect.
Lice \ Licens .: 672285
at ntractor: I,v)
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 morethan 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. , 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
WORKER'S COMPENSATION DECLARATION
I hereby affirm 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.
-164 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 1247619
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should ome subjec to the rkers' compensation provisions of Section
700 of the Labor s II forth ith omply those provisions.
Jican
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 ($100,000). 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 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 at I have read this application and state that the above information is correct. I agree to comply with all
city and oun pogrdinances and state laws relating to buildi co ructi and here authorize representatives
of i t mer upon the above-mentioned propryf{f r ecti pur ses.
e: 1• Sign re (Applicant or Agent): C
Application Number . . . . 07-00000469
Permit . . . . . WALL/FENCE
PERMIT
Additional desc
Permit Fee 63.00•
Plan Check
Fee
.00.
Issue Date
Valuation
3245
Expiration Date 8/12/07
` Qty Unit Charge 'Per
Extension
BASE
FEE
45.00
2.00 q.nnnn THOU BLDG
2,401-25,000
18.00
Special Notes and Comments
------
85 L.F. 6' GARDEN WALL, 70 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