05-1846 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 005=0'000°184"6
Property Address: 8T1`83 SANTA ROSA CT
APP: 764-270-999-27 -300234-
Application description: WAL.t/FENCE
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 8840
Applicant:
Tihf 4 41 a- ".
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
D Q D
JUN 0 3 2005
CITY OF LA QUINTA
FINANCE DEPT _
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9. (commencing with
Section 7000) of Division3 of the`Business andProfessionals'Code:'andmy License is in full force and effect.
License Class B . ` . /I License'No.: 672285' "
..Date: ntractor. Gl� wok 4-5 _
OWNER-BUILDEROECLARATION. '
I hereby affirm under. penalty ofperjurythat, am exempt from the Con6iiior's State License Law for the,
following _reason (Sec. 7031.5, Business and,Professions Coder Any city or county that requires a permit to,
cdnstruct, alter, improve,,demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement he or she is licensed pursuant to the provisions of theContractor's State
-
License Law IChapter9;lcommencing with Section .7000) of Division 3 of the Business and Professions Code) or
that he or is exempt therefrom and the basis for the '11_6 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(5500).:
as owner of.the'property, or'r6y 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$r improves thereon,
and who*does the:work`,himself or herself through his�or herown'emplgyees; provided'.thatahe
improvements are:not intended or offered. for sale..If, however, the buildirig of improvement is soldwithin
one year of completi(in, the owner -builder will havetheburden of proving that he or she did not build or
improve for,the purpose ofsale.).
(_ 1 1, as;owner. of the property;.am:ezclusivelycontracting with licensed contraotors.to construct the project (Sec.
7044 Business and Professions Code: The Contractors:,Stateiicense Law does not apply,to-an owner of
,property w o•builos or improves thereon, and who comiacts fior the projects with a contractor(s) licensed
pursuant �to the Contractors' State License Law.). -
1 _ 1 I am exempt under Sec. B.&P.C.'for this reason
Date: Owner: -
CONSTRUCTION LENDIWG 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: I
Lender's Address: I F(
LQPERMIT
Owner:
SHEA 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)-177-6005
LiC: No.: 672285
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/24/05
WORKER'S'COMPENSATION DECLARATION '
hereby affirm under penalty of perjury one of•thefollowing"declarations: -
I have and`will maintain a certificate ofconsent to self -insure for. workers' compensation, as provided
for by Section 3700 of the Labor Code, for & performance of the work for which this permit is
issued.
I have and.will mamtain;workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the.work forwhich this permit is issued. My.workers' compensation
. insurance carrier and policy number'are:
Carrier NTL`- UNION': INS` Policy Number 6436568'.
I certify that, in. the performance of the work for which this;permit-is issued,.I shall not employ any
.person in any manner;so'as to become subject to the woikeis' compensation laws of California; '
and agree that'if -I should -,become subject to the workers` compensation provisions of Section
3700 of the Labor�Code',I.shalj fort with comply with those_, provisions
ate: li
_ WARNI�N-G:FAILURE TO SECURE WORKERS' COMPENSATION.COVERAGE IS UNLAWFUL, AND SHALL
SUBJECTA . N EMPLOYER TO.CRIMINAL PENALTIES AND CIVIC FINESUP TO,ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION,TO'THE ECO ST OF COMPENSATION?DAMAGES AS PROVIDED FOR IN
SECTION 37O6OF�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'setforth�on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for
whose,tienefit 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.
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
permit to cancellation. -
I certify that I have read this app cation and state that the above information is correct. I agree to comply with all
city and county ordinances�� state laws relating to building construction, andhereb authorize representatives
of this count to enter u n the above-mentioned property f spectionpurpos
ate: Signature (Applicant or Agent):
77
LQkTRMff
Application Number, . . . . 05-00001846
Permit . . . WALL/FENCE,PERMIT
Additional desc .
"Permit Fee 108.00
Plan Check Fee
.00
Issue,Date . . . .
Valuation .
. 8840
Expiration Date 11/20/05
Qty Unit.Charge Per
Extension
BASE
FEE
.45.00
7.00 9."0000 THOU "BLDG
2,00.1-25,000
63.00:
•.
-------•-----------------------------------
Special Notes and•,Comments
---------------------------
'
`28Q L:F'.':6'. GARDEN WALL, 115 L.F•:
3'
RETAINING- WALL;- BOTH"`bRCO:`SYSTEM
Fee., summary -". Cl arge`dPaid
Credited.'
Due
_
- ----- - - --
Permit Fee Total- 108:A.0 --------00
-- - - -----
--- 00
108--
00
Plan Check Total "00..:
:, . 0.0 .00.
: 00
Grand" Total 108.00"
.00 .00
108.00
LQkTRMff