04-7977 (BLCK)IF—:;
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
Application Number
Property Address . . . .
APN:
Application description
Property Zoning . . . . .
Application valuation . .
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
04.-000..0.7977.
81160 RED ROCK RD.
764-270-999-152 =300233-
.. WALL/FENCE
MEDIUM HIGH DENSITY RES
4255
Date 12/30/04
Owner Contractor
SHEA LA QUINTA SHEA HOMES, INC.
C/O JEFF MCQUEEN 81260 AVENUE 62
8800 N GAINEY CENTER 350 LA QUINTA, CA 92253
SCOTTSDALE, AZ 85258 (760)777-6005
WCC: NTL UNION INS
WC: 6436568 08/01/05
CSLB: 672285 06/30/05
CCC: B
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v
JAN 13 2005
CITY OF LA QUINTA
ren. a,..�_ _
P.O. Box 1504 •
4
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 79 7I Date:
Applicant: Architect or Engineer:
Applicant's Mailing Address:
Architect or Engin ee 's Address:
�n
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provis' ns of C apter 9 (comme ing i h Section 7000) of Division 3 of the Business and Professionals
Co , and my Licy101I in full force and effect. �1
kens Class �nse No.
Date .ctor
k&
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).):
U 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 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 or 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.).
U 1, 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.).
U I am exempt under Sec. , BA P.C. for this reason
Date
WORKERS' 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 te rk for which this permit is issued.
�ave"ean,wdojl wintain workers' compens ion insumn e, as required by Section 3 0 of t e Labor Code, for the performance of the work for which this permit is
. My doers' compe do toe
carrier nd is a ar�
Amer licv Number
I certify that, in the performance of the work which this permit i issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Califomia, nd agr a that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those i ions. FZ
/ Date- O� pplicant
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.
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
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 Ouinta, 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 ommenced 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 above information is correct. I agr o comply with all city and county ordinances and state laws relating to building
constru ion, and ereby authorize r presentatives of this county to n the above- ne erty for inspection purposes.
ate ��ignature (Applicant or Agent):
s"-------------------------------------------------.---------------------------
Application Number . . . . . 04-00007977
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Permit WALL/FENCE PERMIT
Additional desc
Permit Fee w X72 00. Plan Check Fee 00
Issue Date Valuation . . . . 4255
Qty -Unit Charge Per. Extension
BASE FEE 45.00
3.00 9.0000 THOU BLDG 2,001-25,000 27.00
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Special Notes and Comments
135 L.F. 6' GARDEN WALL, 55 L.F. 3'
RETAINING WALL, ORCO SYSTEM
Fee summary Charged
----------------- ----------
Permit Fee Total 72.00
Plan Check Total .00
Grand Total 72.00
Paid Credited Due
---------- ---------- ----------
.00 .00 •72.00
.00 .00 .00
.00 .00 72.00
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