05-2836 (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:
05-00002836
81098 BARREL CACTUS RD
764-270-999-40 -300233-
WALL/FENCE
MEDIUM HIGH DENSITY RES_
at'vne4c"T-0 K
592
Arc
Ti -ht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am lice ed unapr provisions of Chapter 9 (commencing with
Section 7000) of i Sion Busine and Profs ' na Code, and myJdt;e� �251 full f7e effect.
Licen a Class: icense No.: �J (
Contractor. r
OWN&SlIrLDER 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 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 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
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that therejs 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/08/05
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350
SCOTTSDALE, AZ 85258
Contractor:
CALIFORNIA POOLS & SPAS
WCC: SEABRIGHT INS
WC: BB1050510 01/01/06
CSLB: 656128 10/31/06
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ 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
V issued.
n I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
-T Code, for the performance of the work for which is it is issued. Mrker� omp ensation
insurance carrier and policy number are: ` / Gin
Carrier CB C27 C29 C53 Policy Number V
_ I certify that, in the performance of the w or which this permit is issued, I shall not emp oy any
person in any manner so as to becom s bjec o the workers' compensation laws of California,
and agree that, if I shoul eco me su ec t workers' compensation provisions of Section
37 00 off he Labo/r Co shall fort ith co ly with those provisions.
ate: L 6JAppliganf:
WARNING: FAILURE TO SECURE RKERS' OMP TION 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 cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the b informa o is cor ct. I agree to comply with all
city and county ordinances and state laws relating to bui c nstructi , an eby authorize representatives
of this-ccoouunty b a er upon the above-mentioned pro for nspectio purp
ate: T�D 0.6 nature (Applicant'or Agent):
Application Number . . . . . 05-00002836
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 17.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 592
Expiration Date 1/04/06
Qty Unit Charge Per
Extension
BASE - FEE
15.00
1.00 2.0000 HND BLDG 501-2,000
2.00
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Special Notes and Comments
37 L.F. 4' BLOCK WALL, CITY`STANDARD.
Fee summary Charged Paid
-------------------------------------
Credited
----------
----------
Due
Permit Fee Total 17.00
.00
.00
17.00
Plan Check Total .00
.00
.00
.00 _
Grand Total 17.00
.00
.00
17.00
LQPERMTT