04-7905 (BLCK)\14
I
P.O. BOX 1504 T4'yl 4 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: 12/20/04
Application Number: 04'-"00007905 Owner:
Property Address: 82 BARREL CACTUS RD SHEA LA QUINTA
APN: 764-270-999-33 -300233- C/O JEFF MCQUEEN
Application description: WALL/FENCE 8800 N GAINEY CENTER 350
Property Zoning: MEDIUM HIGH DENSITY RES SCOTTSDALE, AZ 85258
Application valuation: 3075
Contractor: D e
Applicant: Architect or Engineer: SHEA HOMES, INC.
81260 AVENUE 62 DEC 2 3 2004 t
LA QUINTA, CA 92253
(760)777-6005CITY OF LA QUINTA
Lic. Noo..::667272285 FINANCE DEPT.
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby 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:
Section 70 01 of Di ision 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Cla's: B License No.: 672285 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
ssued.
Date nt ctor: - 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 AE166ier NTL UNION INS Policy Number 6436568
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 thew 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 person in any manner so as to becom bject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I sho become ect to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code) or 11 L_ 700 of the or shal ortit comply with 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).:
(_ 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 am exempt under Sec. , B.&P.C. for this reason
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
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 cessa n of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that t ab ve infor ati is correct. I agree to comply with all
city and c my o`dinances and state laws relating t.1 u g nstr ,and hereby authorize representatives
of th' F�'ypu, ty to nter upon the above -mention proper or spectio purposes.
�tef nature (Applicant or Age
Application Number . . . . . 04-00007905
Permit . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee 63.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 3075
Qty Unit Charge Per
Extension
BASE
FEE
45.00
2.00 9.0000 THOU BLDG
2,001-25,000
18.00
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Special Notes and Comments
75 L.F. 6- GARDEN WALL, 75 L.F.
3'
RETAINING 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
LQPERMIT