07-1792 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 0.7-00001792
Property Address: 81820 RUSTIC CANYON DR
APN: 76.4-280-999-77 -30023'7-
Application description: WALL/FENCE
Property Zoninq: MEDIUM HIGH DENSITY RES
Application valuation: 2250
Applicant:
Tjht 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:.
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350
Ar nTTSDAT F; AZ R575R
Contractor:
SHEA HOMES, In
60800 TRILOGY
LA QUINTA, CA
(760)777-6005
Lic. No.: 6722
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/20/07
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LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I herby 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: '
Secti n 700 of Division 3 of the Business and Pro ss nals Code, and my License is in full force and effect.
_ I have and will maintain acertificate of consent to self -insure for workers' compensation, as provided
en lass i nse No.: 672285
- for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
ate: tractor:.
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
permit to file a signed statement thathe or, she is licensed pursuant to the provisions of the Contractor's State
person in any ma er s s to become subjec o the workers' compensation laws of California,
and agree tha uld eco subj€ct to workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
0 of the abor o I hal
fo ith c h 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).:
Date: Iiic
(_ 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 (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.).
(-) 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. 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: PIT
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 Ouinta, 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 ave read this application and state that the bove information is o rect. I agree to comply with all
n coun ordinances and state laws relati t ' i co ti n, authorize representatives
o i ty o er u on the above-mentio d pro ert r in ect purpos
a�b te: gnature (Applicant or A
I
LQPERMIT
Application Number
07-00001792
Permit
WALL/FENCE'PERMIT
Additional desc .
Permit Fee . . .
. 54.00
Plan Check
Fee
00
Issue Date . . .
.
Valuation
2250
Expiration Date
12/17/07
Qty Unit Charge
Per
Extension.
BASE FEE
.45.00
i nn 9.0000
THOU -BLDG 2,001-25,000
y.UU
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Special Notes and
----------------
Comments.
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90 L.F. 6' GARDEN
WALL, ORCO SYSTEM
Fee summary
Charged Paid
Credited
Due
Permit Fee Total
54.00
.'00
.00
54.00
Plan Check Total
.00
00
.00
.00
Grand Total
54.00
.00
.00
54.00