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05-1847 (BLCK)' Tit* BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 05000OT8477f Owner: Property Address: 8-1-154�SANTA ROSA CT SHEA LA QUINTA APN: 764-270-999-26 -300234- C/O JEFF MCQUEEN Application description: WALL/FENCE 8800 N GAINEY CENTER .350 Property Zoning: MEDIUM HIGH DENSITY RES n a SCOTTSDALE, AZ 85258 Application valuation: 6160 (� JUN. CO 3 200C PF1 Contractor: Applicant:'Architect or Engine N J SHEA HOMES; INC. 81260 AVENUE 62 s CITYOF aQUINTA LA QUINTA, CA •92253 r FINANCE DEPT- (760) 777-6005 1 I Lic. No.: 672285 VOICE. (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 . Date: 5/24/05 LICENSED CONTRACTORS DECLARATION •, . -----------------------------------------— WORKER'S COMPENSATION DECLARATION. - I hereby affirm under .pgnalty of perjury that I am licensed under. provisions of Chapter 9 (commencing. with I hereby affirm under •penalty of perjury one of'tliefollowingdeclarations: ' . ,Section 7000) of Division -3 of the Business and Professionals.Code, and my License is in full force and effect. I have and -will mainiain a.6.f.cate7of. consent toself-insure for workers' compensation, as provided - _ •LicenseCl ss. B., - LicenseNo.: 6.72285 - _ for by Section 3700of the Labor Code, for the performance of the work for which this permit is f / Date:Wa�!77_�.tractor::/hQ/�1�i� issued.' ..,. .._ 14, 1 have.and will maintain workers' compensation insurance, as required by Section 3700 of the Labor -V' Code, for the performanceofthe work for which this permit is issued:.My workers' compensation - - - - OWNER -BUILDER DECLARATION - insurance carrier and policy numbegarei' I hereby affirm under penaltyof,perjury that I am exempt from the Contractor's State License Law for the Carrier 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 the work� for. which this permit is issued, I shall not employ. any construct, alter, improve demolish, or, repair any structure,. prior to itsissuance, also requires the applicant for the person in any manner;so'as to•become:subject to the -workers'. compensationlaws of California, permit to'file a srgned:statement that he'or she is licensed pursuant to theprovisrons:of the :Contractor's State and agree that; if I§hould become subject. to;the,workers' compensaiion,provisions-of.Section License-Law.(Chapter:9 (commencing with Section 7000),of.Divisiori-3:of the.Business and Professions Code) or ., that he she is exempt therefrom and the basis forthe.alleged exemption. Any violation of Section 7031:5 by any applicant for a permit subjecis the applicant to a civilrpenalty ofnot more than five hundred dollars 155001:: - 3700 of the Laboc Code, l shall fo wrth;comply with those provisions. "' • 1 _J .I, as owner of the property, or my employees with wages as their sole comp ensation,mill do the work, and the structure is not intended or -offered for'sale.(Sec. 7644 Business and'Professions Code: The -WARNING:`.FAICURE TO:SECURE WORKERS';�COMPENSATIO_N COVERAGE -1S UNLAWFUL, AND SHALL Contractors"i StateLicense Law Aoes.not.apply4o an owner otproperty who•builds or improves thereon, SUBJECTAN EMPLOYER,TO CRIMINAL=PENALTIES AND CIVIFFINES UP TOONE HUNDRED' THOUSAND anif-whodoes the work himself or herself. through his ortier own'employees, provided that the DOLLARS IS100,000L IN ADDITION.TOTHE COST.OF COMPENSATION, DAMAG_ES'AS PROVIDED FOR IN improvements are not intended or offered for sale.; If; however, thebuilding or improvement is sold within SECTION 3706 OF7HELABOR CODE,INTEREST;,AND ATTORNEY'S FEES. • one year of completion, the owner -builder, will, have the burden ofproving*that he'or she did not, build or- . .improve for the purpose of sale.).., + r'' ' - • •'• APPLICANT. ACKNOWLEDGEMENT - - •(_ 1 1, a! owner of the•pr'operty; am exclusively contracting -with licensed contractors to construct the project (Sec. - IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the - ,. 7044,;Business -and -Professioris;Code:,•The Contractors'. State,License LawAcies not applyao an owner of- conditions and restrictions set forth on this'application. ^• • •� • - -�"` ' property who builds or improves thereon,'and who contracts for.the projects with a'contractor(s) licensed - 1. Each person uponwhose.behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). - whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_) I am exempt under Sec. , B.&P.C. for thisreason 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. .. Date: Owner: 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 ' CONSTRUCTION LENDING AGENCY' permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performarice of the I certify that I have read this application and state that the above information is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and tate laws relating to building construction, and hereby authorize representatives of this cou y enter upo eabove-mentioned property for inspection pi p Lender's Name: /y. ate: Signature (Applicant or Agent): IF Lender's Address: f'1 LQPERMIT Application -.Number 057-00001847 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee 90.00 Plan Check Fee .00 Issue. Date . . Valuation . . . . . 6160 Expiration Date 11/20/05 Qty Unit Charge, Per. Extension BASE FEE 45.00 5.00 _ 9.0000 THOU BLDG.2',001-25,000 45.00 ------------------------------ Special:Notes and Comments 385 L.F. 3''RETAINING:aWALL,ORCO SYSTEM Feersummary Charged Paid..'_ Credited Due ----- Permit Fee -Total 9,0,°00. 00 - 00 --- 90:00' Plan .Check Total. .0.0 00 -' .00 .00 Grand:Total 90:0.0 .00 .00 90.00 yam. Al .