05-1848 (BLCK)ul�(rGv
1 1 ..
P.O. BOX 1504 _ VOICE (760). 777-7012
78 495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7.153
BUILDING PERMIT
Date: 5/24/05
Application Number:05=0'0001848` Owner:
Property Address: 81166 SANTA ROSA CT SHEA LA QUINTA
APN: 764-270-999-25' -300234- C/O JEFF MCQUEEN
Application description: WALL/FENCE n — 8800 N GAINEY CENTER 350
.Property Zoning: MEDIUM HIGH DENSITY RES a SCOTTSDALE, AZ 85258
Application valuation: 4045 D
JUN .0 3 2005.
,Contractor:
Applicant;,.._ :a Architect or E gjn_ , r: SHEA HOMES, INC.
CITY OF, LAQUINTA''- 8126.0 AVENUE 6'2
"FIPIAPdCEDEPT: LA QUINTA, CA '9225_3.
/nom (760) 7,77-6005
Lia" No.. 672285
,._a. LICENSED CONTRACTOR'SDECLARATION - - WORKER'S COMPENSATIONrDECLARATION
hereby affirm under-penaltyof;pe'ryury that,larn licensed under provisions of.Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations -
"~ _Seaiond00o) of.Divisi6n-3 of the eusines`s arid' Professionals Code,.and'my License is in full,foice and effect. _ -I have.and -will maintains certjfickei,of,consent to self-insure'for'v;orkers' compensation, as provided
:License CI" s• ' B. License No.: 672285•' for by Section 3700. of the Labor Code for:.the,performance'of the work for which this permit is '
`va � � ,,'r
•'' _ ate .. ntractoc .�8// '� - 1 -have and::will maintain workers' compensation insurance, as required by Section 3700 of the.Labo7_
>�, OWNER=BUILDER'DtCLAFtATION
I Hereby affirm under: penalty, of perjury.that. I exempt'from,the Contractor'srState'License Law for the
following reason (Sec. i631 5 -:Business and:Professions Code:Any city or county�that.requires_a permit to
.construct, alter,;improva demohsh;•or repair"anystructure prior to its issuances also.requires the.applicani%r the
PC to file a signed statement that'ha or: she is licensed pursuant. to I a provisions ofthe'Contractors,State
Liceii eLaw,IChapter 9 (ccmmehcing with Section'70001 of Division,3:ofthe Business-anC Professioris�-Codel or .
that he.or;she is exempt therefrom and the basis for the alleged ekempbon ..Any wolatid6'of;Section 7031 5'by
. any applicant for a.permit subjects the, applicant to a civil;penalty of{not more than five hundred dollars (55001:
(_ 1 1,:as owner -of the property or my,employees wr4h wages as'fheir sole compensation, will do the work; and
the structure is -h-60 tended oroffered fog sale (Sec 70,44 -Business and`Professions Code: The,'
Contractors',State'License Law does not.apply'to ori owneEof.prope"rty whcrbuilds or' improves4here6n,.
and: who does,.the-work himself,or'herself.through his Daher own.`e`mployees,provided that.the
improvements are novintended or.offered.for sale '-If,:however-"the:buwldin'b,&'improvement Wsold, within
one year-of,completi6n, the owner -builder will have the burden'of,proving that he orshe did not build or
improve -for. the purpose of sale.). ..
(_) 1, as, owner of the property, am,exclusiyely contracting with licensed contractors,to construct the project (Sec.
.. 7044, Business a40rofessiom Code The Contractors` StatejLicense L•aw':do'es not'applyto.an owner of"
Properly 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:Secr , 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 (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
,Code,.for the performance of,the- work .for which this permit isissued: My workers' compensation
- insurance..carrierand:policy'number-are:
Carrier NTL UNION: INS` Policy Number 6436568
_ I'ce fy'-that, in the performance of�the-work for which this.permit is issued; I shall not employ any
'persoro in any manner so as to�tiecome subject to the workers' compensation'laays of California, '
and agree:that; if I should become.subiect to the workersS`compensation provisions of Section .
. .3700 of'the`Cabor Code Ishall;forttiwithcomply withthose provision's. ,.: �-:�•� ,
ate:. BS ioant: SLS'
t�
WARNING^.FAILURE TO SECURE-WORKERS.`CONIPENSATION COVERAGE IS'UNLAWFUL, AND SHALL-.
SUBJECT AWBE IPLOYERTO'16ill IINAL'PENALTIES AND: CIVIL FINES UP TbfONE HUNDRED THOUSAND `
DOLLARS,($.100,000). IN ADDITION TO THE COST�OF COMPENSATION; DAMAGES' -AS PROVIDED FOR "IN
SECTION 3706 -OF THE:LA80R CODE, INTEREST, AND ATTORNEY'S -'FEES. .�
•� APPLICANT ACKNOWLEDGEMENT _
IMPORTANT Application is hereby made to the'136ector of Building and Safetyfor's permit subject`to the
conditions"a4restrictions set forth oo this'application:• �- .,>'�. •».a,.,,:,� %e;.�• ;,Jp 3- ..,,ts:. .,
' 1. Eachperson' 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 result of this application,
the owner,.end the applicant, each.agrees;to, and shall:6fend, indemnify and hold "harmless.the.City "
of La Quint a,'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 oUissuance of such permit, -or cessation of work for 180 days will subject
permit to cancellation.
Icertify that 1 have'read this application and state thatthe above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
;ofhis courp IT enter upon th ove-mentioned property �specvon e .
nature,(Applicant or Agent):.
LQPERMIT
Application Number . . . 05-00001848
Permit . . . WALL/FENCE
PERMIT
Additional desc .
Permit -Fee . . . . 72.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. .
. . 4045
Expiration Date 11/20/05
Qty Unit Charge Per
Extension
•
BASE
FEE
45'.00.
3.0,0 9.0000 THOU BLDG.2,001-25,000
.27.0.0
---------------------------------
Special, Notes and Comments
------------
------------
85. L.Pc 6'' GARDEN:WALL, 12.0 L.F.
3'
'
RETAINING WALL, BOTH ORCO SYSTEM
Fee summary Charged
Paid
Credited
Due
.3r
..
------------------ - - - - - - - -
Permit Fee Total 72.00
- - - - - -
- - - ----------
.00
.00
- _ _ _
72.00
g`.
Plan -Check Total .00
.00
.00
00
Grand Total 72.00
.00
.00'
72:00.
LQPERMIT