06-1410 (BLCK)n�
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4ht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
1/ r INSPECTIONS (760) 777-7153
Date: 4/06/06
Application Number: 06-00001410
Owner:
Property Address: 61205 CACTUS SPRING DR
SHEA LA QUINTA
APN: 7647280-999-153 -300235-
C/O JEFF MCQUEEN
Application description: WALL/FENCE
8800 N GAINEY CENTER 350
Property Zoning: MEDIUM HIGH DENSITY RES A
I SCOTTSDALE, AZ 85258
Application valuation: 6460 D
APR
�tOA�Applicant:
1 I Contractor:SHEA
Architect or Engineer:
HOMES, IN.C.
81260 AVENUE 62
•.; - LA QUINTA, CA 92253
y _
(760)777-6005
LiC. No.: 672285
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LICENSED CONTRACTOR'S DECLARATION -
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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 7000) of Division 3 of the B 'n ss and Prof ss nals 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
Lice�Intract�,.
cense No.: 672285
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
!It
f
issued.
at
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 u ber 1247619
following reason (Sec. 7037.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the perfor nce of the r for which this permit is issued, I shall not employ any
or
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so to becom s bject to the workers' compensat on 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 shou b ome su ' enation p ovisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3b00 of the Labor fo ith with those prow
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
L J+�•/V
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 155001.:
D
ica
(_ 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.).
(_ 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. , BAP.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.I.
Lender's Name:
Lender's Address: IF
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 Guinta, 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 certiftc
have ead this application and state that a above information is correct. I agree to comply with all
C
ordi a ces and state laws relating to b con ructi , and hereby authorize representatives
Of t isto n r pon the ove-mentioned prop fo i purposes.
D e: ture (Applicant or gent
Application Number . . . . . 06-00001410
Permit WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 90.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 6460
Expiration Date . . 10/03/06
Qty Unit Charge Per Extension
BASE FEE 45.00
5.00 9.0000 THOU BLDG 2,001-25,000 45.00
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Special Notes and Comments
220 L.F. 6- GARDEN WALL, 60 L.F. 3'
RETAINING WALL, BOTH ORCO SYSTEM
Fee summary Charged Paid Credited Due
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Permit Fee Total 90.00 .00 .00 90.00
Plan Check Total .00 .00 .00 .00
Grand Total 90.00 .00 .00 90.00
LQPERMIT