05-5210 (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:
�•: 05-00005210
81154 SANTA R'OSA CT
764-270-999-26-300234-
-WALL/FENCE
MEDIUM HIGH DENSITY RES
3550
Architect or
Pi
TUIVI
",
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SH EA LA QUINTA
C/O.JEFF MCQUEEN
8800.N GAINEY CENTER 350
SCOTTSDALE, AZ 85258
Contractor:
SHEA HOMES, INC.
81260 AVENUE 62
LA,QUINTA, CA 92253
(760)777-6005
Lic.-No.: 672285
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/29/05
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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 perjuryone of the following declarations:'
7000) f Division 3 -of the Business and Professionals Code, and my License is in full force and effect.
Secti4s�elaks.
_ I have and will maintain a certificate of consent -to self -insure for workers' compensation, as provided
Lice
se No.: 672285
for by Section 3700 of the Labor Code, forthe performance of.the work for which this permit is
_issued.Datv
-I
ontractor.
have and will maintain workers' compensationinsurance, 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:
Ihereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier AMERICAN :HOME Policy Number 1247619:. -
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county. that requires a permit to
ich this permit.is issued, I shall not employ any
_ I certify that, in'the performance of t4subje'
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 6ecthe workers' compensation laws ofrCalifornia,
•meworkers'
permit tofile a signed'staiement that he or she is licensed pursuantto the provisions of theContractor's.State
d agree that, if I s compensation provisions of Section
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
3 00 of the Labor sh Ifo with those. provisions. .'
- -
any applicant for a permit subjects the applicant to a civil•penalty of'not more than five hundred dollars ($500).:
icant.��
(_ 1 I, as owner.of the property, or my employees withwages as their sole compensation, will do the work, and
the structure isnot 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 wtio 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 there is a construction lending agency for the performance of the
.work for which this permit is issued ISec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE is UNLAWFUL, AND SHALL
SUBJECT SAN 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 orrthis 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.
21 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 work for 180 days will subject
permit to cancellation.
I certify t at 1 have read this application and state that the bov inform on is rrect. I agree to comply with all
ci y and unty dinances and state laws relating to' I co structi hereby authorize representatives
o 1 co n to me upon the above-mentioned operf for ' pection pur os
e. nature (Applicant or Age '
. r
Application Number . . . . . 05-00005210
Permit . .
. WALL/FENCE
PERMIT
Additional desc .
.
Permit Fee . . .
. 63.00
Plan Check
Fee
.00
Issue Date . .
Valuation
. . .
. 3550
Expiration Date
5/28/06
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
142 L.F. 6' GARDEN
WALL, 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