07-1794 (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:
r-07=00_0.01794_)
81856 RUSTIC CANYON DR
764-280-999-74 -300237-
WALL/FENCE
MEDIUM HIGH DENSITY RES
2250,
Tit!t 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED
CONTRACTOR'S DECLARATION
I h reby ffirm under penalty of perjury th I am lic nsed under provisions of Chapter 9 (commencing with
Se ion 7 001 of Division 3 of the B and Pro s o aIs Code, and my License is in full force and effect.
tic 'cense No.: 672285
�r t Co _ cto .
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).:
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 _ 1 I am exempt under Sec. B.&P.C. for this reason
f 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: If iin�
Lender's Address: '
LQPERMIT
Owner:
SHEA LA QUINTA
C/O JEFF-MCQUEEN ,
8800 N GAINEY CENTER 350
SCOTTSDALE, AZ 8.5258,
Contractor:
SHEA HOMES, INC.
60800 TRILOGY PARKWAY
LA QUINTA, CA 92253 '
(760)777-6005
Lic. No.: 672285
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/20/07
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 Secti6n'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 er so s to be orae subje t to the workers' compensation laws of California,
and agree th , if I bec a bject to h workers' compensation provisions of Section
3700 of th a r o shal ort 'th 'th those provisions.
ate: I' a
WARNING: FAILURE TO S E 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 pursuantto'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 ce ify th t I have read this application and state that the bov information is correct. agree to comply with all
W.yt.:�ou
A�y ordinances and state laws relating -to bu' on ruc i and rize representatives
�ignature
enter upon the above-mentioned pro rtyfre�ti n p rp ses. (Applicant or Agent. u
Application Number
. . . . . 07-00001794
Permit . .
. WALL/FENCE PERMIT
Additional dese .
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
THOU BLDG 2;001-25;000
9 nn
Special Notes and
-------------------------------------
Comments
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