07-1797 (BLCK)P.O. BOX 1504 Qum&
78-495':CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: `ti,07--000017917
Property Address: 81841 RUSTIC CANYON DR
APN: 764-280-999-48 -300237-
Application description: WALL/FENCE
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: .2250
Applicant: Architect or Engineer:
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
' Secti 7qW) of Division 3 of theBusin and Profe io a Code, and my License is.in full force and effect.
c n as ' c se No.: 672285
ate: Coactor:
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 more than five hundred dollars ($500).:
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
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:).
( 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.).
1 _ I I arr 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:
LQPERDIIT
Owner:
SHEA LA QUINTA .
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350
SCOTTSDALE, AZ 85258
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/20/07
Contractor: D A U. 0
SHEA HOMES, INC.
60800 TRILOGY PARKWAY 9
LA QUINTA, CA 92253 JUL Q2 2007
(760)777-6005
Lic. No:: 672285 CITY OF LA QUINTA
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WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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.
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
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 subi to the workers' compensation laws of California,
and agree that o IdYc' e substte w rkers' compensation provisions of Section
3700 of th ab d , f h ith c y wi those provisions. '
Date. p1
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 Quima, 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 certMount
have-read this application and state h above information is rrect. I agree to comply with all
aor inances and state laws relati to b i ' con ction, and rebs authorize representativesof t i a on the above -mention d prop rty ins c o p o
ate: ture (Applicant or Agen '
Application Number 07-00001797
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
1:00 9.0000 THOTT RTnr, 2, nni
-2S, nnn
9.40
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Special Notes and Comments
90 L.F. 61. 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
LQPERMIT