05-1849 (BLCK)! -P.O. BOX 1504
78-495 'CALLE TAMPICO
LA QUINTA, CALIFORNIA.92253
Application Number:05-00001849
' ,
Property Address:
81178 SANTA ROSA CT
APN: .+
764-270-999-24 -300234-
Application description:
WALL/FENCE
,.Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
3760
Tiht °� �wQ�«rw
BUILDING & SAFETY DEPARTMENT
BUILDING. PERMIT
Owner:
SHEA LA QUINTA
C/O JEFF.MCQUEEN
8800 N GAINEY CENTER 350
SCOTTSDALE, AZ 85258
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS. (760) 777-7153
Date:5/24/05
II Contractor:
Applicant: Architect or Engineer: D SHEA HOMES, INC.
81260 AVENUE 62
JUN 3 ZOOS LP; QUINTA, ' CA 92253
,`,�/� .• (760)777-6005
CITYOFLINTA Lic. No.: 672285
FINANCE AQUDEP
-––––––––––––––-––––––––––––––––––––––—
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 affirmiunder penalty of perjury one.of-the following declarations:
Secuon'7000) of; Division 3 of the Business and Professionals 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
License-Cl� s B _ License No.: 672285 for by;.Se'ction 9700 -of the Labor Code, -for the performance of the.work for which this permit=is.
_ issued. ..
ate ontrector:` y..�A I'have and will maintain workers: compensation insurance; as required by Section,3700 of the.Labor
' "Code,fo 'the, performance of_the, woik for which this permit is issued. My workers',compensation
OWNERBUILDER"DECLARATION . ,r - - insurance carrier and policypumber are:` _ -
I herebyaffirm underpenalty of,peryury ttiatd,am exemptfrom'the Contractor's State License Law for the Carrier NTL tJN30N..-INS `- Policy Number b43:6.568
following reason Isec. 7031,5, Busme s avid Professions Code: Any city or county that 64uires.a:permit to _ I ceitify, that, in the performance of the -work for which this permit is issued, I shall, not employ any
c:=, alt improve, demolish, ocrepair any'structure, prior to its issuance, also requires the applicant for the person:in-any�mannerso as`to-..become subject to the workers.compensation..1
permit to file_ signed_ statement that he or'she islivensed pursuant to theprovisions:of.the Contractor:sState. and agree:that; if I,should become subidc to the'workers' compensation provision"s'of'Section
License Law. (Chapter'9 (commencing with:Section 7000) of Division 3 of the Business and Professions'Code) "or .,3700 of the Labor Code, I hall forthw' h comply.:with-those provisions.
rthafhe or she is exempt therefrom -and tlie*basisfor the alleged exempnon*Any violation of SectionJ031.5 by `- �''*
any applicant for a; ermit subjects thea licantto a civil'penaltyof not more than five hundred dollars ($500).: - ate. A plicant: s
(_) I, as.owner ,ofthe property, or my employees with wages'as their sole'compensatiori; wilLdo the work, and
- - the structure.is'not tintended or offered for sale (Sec. 7044:Business and -Professions Code:'The. - W'ARNIN :,FAILURE TO SECURE -WORKERS: COMPENSATION COVERAGE IS'UNLAWFUL, AND SHALL
.Contractors" State'License Law does not apply,Ito'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 th'e workthimself 'ocherseIf through his.or her. own` employees;'provided that the DOLLARS ($100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED •FOR IN
improyements aie'not intended or'off. ed i'or-sale. le, however, the building.or irtiprovementis sold within SECTION 3706 OF THE LABDWMDE,'INTEREST, AND ATTORNEY'S FEES.
one year of completion, the owrier-builder will have the burden oi$!oving.that he or she did, not build or - -
improve for the purpose of. sale:). '' r APPUCANTACKNOWLEDGEMENT
(_) I, a''s owner of the property,,am exclusively contracting with licensed contractors to construct the project (Sec: - IMPORTANT Application. is hereby made,to tne,Director of Building and Safety, for a permit subject to the
7044,. Business and: Professions Code: The Contractors' State License Law does not,applyto an owner of conditions and restrictions set forth on this application. .K„ .. rt•a -
at:
prpperty who builds or improves thereon-;and,who contract for the projects with a,contractor(sldicensed' � � -' "1 . • Eacti'person upon whose behalfthirapplication is made, each person at whose request and for
pursuant to the 'Cohiractors' State License Law.). - - - whose benefit work' is performed under or pursuant to. any permit issued as result of this application,
(_) I am exempt under Sec. ; B.&P.C, for this reason 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 performance of the 1 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.I. city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this co//y/pmt/y(/�J=.Ue—enter upon th -above-mentioned propertyfor' pectionpurposes.
Lender's Name: / '
Q- te: ignature (Applicant or Agent):' '
Lender's Address:
LQPERMIT
esve:
Application Number 05-0000184.9
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee 63.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 3760
Expiration Date 11/20/05
Qty Unit_Charge Per
Extension
BASE FEE
45.00
2.00. ..9.0000 THOU BLDG 2,001-25,000
18.00
- ---------- ------------------------------------
Special Notes and Comments
80:L:F: 61 -GARDEN WALL, L;! F. 3'
,110
RETATNING WALL, 'BOTH ORCO SYSTEM:: -`
r
'
Fee summary ChargedPaid Credited
Due'.
.------- --- -----------------------------
Permit Fee .:.Total-•,, 63.00 00 00
63.00.
P1an.Check`Total" 00 00 00
00
Grand Total. 63.00 ..00 .00
63.00
IV
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