07-0478 (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:
07-0000047_8_,_;
81709 RUSTIC CANYON DR
764-280-999-37 -300237-
WALL/FENCE
MEDIUM.HIGH DENSITY RES
3165
Architect or Engineer:
AIA
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350
SCOTTSDALE, AZ'8S2.S8
ry A HOMES, INC.
p U 600 00 TRILOGY PARKWAY
-ED 2 UINTA, CA 92253
(:76M777-6005
�ITYOF_-L'A 16iTA LI 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 _
WORKER'S COMPENSATION DECLARATION
I hereb affir under penalty of perjury that am licensed under provisions of Chapter 9 (commencing with _
I hereby affirm under penalty of perjury one of the following declarations: '
cense is in full force and effect.
U I Lice285
io 700 of Division 3 of the Business nd Profe sionaI C7i:��
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
Datentra.w:
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
_- 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
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
per on in any manner as to become subject to the workers' compensation laws of California,
a agree that, if I oul beco a subject 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
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
00 of the Lab r :sh; o hwit mply with those provisions. '
LA
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
ate: licant: I�/G`//
(_ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is notintended 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 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: Q
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 certifyT at I hale read this application and state tha above information is correct. I agree to comply with all
city and ounty rdinances and state s relating b ding c s uction nd hereby authorize representatives
of L�ja' enter upon the ve-mentione r y for ns ti 706ses.
tae S' ature (Applicant or. Agent):
Application Number . . . . . 07700000478
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 9.0000 THOU BLDG 2,001-.25,000
1.8. 00
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Special Notes and Comments
85 L.F..6- GARDEN WALL, 65 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