05-1851 (BLCK)P.O. BOX -1504
78-495-CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00001851
Property Address: `8-1190 SANTA ROSA CT
APN: 764-270-999-23 -300234-
Application description: WALL/FENCE-
Property. Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 4010
..Applicant:
T- ` ht 4 -4 - Q- ",-,
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
D LJ A LA QUINTA
i JEFF MCQUEEN
0 N GAINEY CENTER 350
JUN 03 2005 TTSDALE, AZ 85258
CITY OF'L A QUIfdTA Co tractor:
-DEPT `
FINANCE. SHEA HOMES, INC.
81260. AVENUE 62
LA QUINTA, CA 92253
(76.0)7,77.-6005,:
Lic. No.: 672285
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/24/05
LICENSED CONTRACTOR'S DECLARATION -,
--------- - - - --—
- WORKER'S COMPENSATION DECLARATION
I hereby affirm underpenalty of perjury that I gm'licensed under provisions of.Chaptei-9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section.7000) of Division 3 of the Business and Professionals Code, and my License i§ in full force and effect.
'672285
_ I have, andwillmaintain a certificate of,consent to self-insurcNor workers' compensation, as provided
License Class: B. > No.:
' -for by Section 3700 of the tabor Code, for the performance of the work for which this permit is
ontractor: '
issued.
'
/Date_:; �i
I have and will maintain. workers' compensation insurance, 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-BUILDERDECLARATION -
insurance carrier, •and policy number -are- -. - -
- I hereby affirm under penalty of peryury that-] am exempt from the:Contractor's State License Law for the ,
Carrier `NTL. UNION! INS : -'-' Policy;Number �64365f68
following reason (Sec. 7031,:5, Business and Professions Code:' Any city or'county-that requires a -permit to
- I bertify;that,.in the. performance of the work for which this permit is issued, I shall not employ:any
construct, alter„improve; demolish, or repaa
ir ny�stiucture, prior -to its issuance,,also requires the applicant -for the
e;
`'person in.any;manen
ner sous to become subject to the Workers' compsation laws of California,
permit•t6file a signed statement •that� he or s6 ,sis; licensed pursuant to the provisions of the Contractor's State
„_ ' and ''agree that; if.l-should becomesubject to the workers: compensation pro3isions of Section
_
License Law (Chapter9 (commencing Wnh'section 7000) of Division 3 of m
the.Busess and Professions Code) or
3700. of the Labor Code, I shall forth * iiI;h.ciimpply with'thoseprovisions. '
that he or she is'iaxempt therefrom and the basis for, the alleged exemption. Any violation of Section 7031.5 by
'. an_ y applicant for a permit subjects the applicant to a civil penalty of not.more than five hundred _dollars ($500).:
ate plicant.-
' 1 1 I, as owner of Ih,e property,:or my. employees with wages as their. sole compensation, will do the work, and
.
' the structure is not,iritended.or offerbd`for sale (Sec. 7044, Business and; Professions Code: The,.
WARNING:,,FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL,
Contractors' State' cense Law does not.apply town ownerof.property who builds-or.improves thereon,
'SUBJECT AN`EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the-
DOLLARS ($100,000). IN ADDITION TO THE -COST OF COMPENSATION, DAMAGES'"AS,PROVIDED FOR IN
improvements are not intended offered for -sale: If, however, the building or improvement is:sold_ within
SECTION. 3706 OF THE LABOR CODE, INTEREST,. AND ATTORNEY'S.FEES.
• 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.). -
APPLICANT'ACKNOWLEDGEMENT -
(_ 1' 1, as owner of, the`propeny, am exclusively, contracting with licensed contractors to construct the. project (Sec:.
IMPORTANT Application is hereby made to'tKe Director of Building and -Safety for a permit subject fo the
7044'Business and P'rofe'ssions Code: The Contractors' State License Law does not apply to an owner of
: ;:conditions andrestrictions set forthionthis _application. _ ; •. ::., ._ �. ..;.e.±' • -
. .. property.Who builds° or. improves thereon, and'who contracts for the projects with a coritractor(s) licensed
-'
1. Each person n upowhose behalfthisapplication is made, each person at.whose r"uest 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,
y _) 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 ofissuance 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
I certify that 1 -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 ISec. 3097, Civ. C.I.
city and county. ordinances and state laws relating to building construction, and hereby out orize representatives
of thi��t he above-mentioned property for ' spection purposes.Lender's
Name:
- ate:e (Applicant or Agent).
Lender's Address: I' I
LQPERMIT
LQPERMTT .
Application Number . . . . . 05-00001851
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 72.00
Plan Check
Fee
00
Issue Date . .". .
Valuation
.
. 4010
Expiration Date 1.1/20/05
Qty. Unit Charge ,Per
Extension
..BASE.FEE
.45.00!,
3.00 9.0000 THOU BLDG
2,001-25,000
27.00:
------------------------ .------------- --------------•---------------------------
Specal Notes and Comments
90 -I;.-F.6', zGARDEN WALL-, 110 'L. F.
3'
RETAINING WALL,, BOTH ORCO SYSTEM
_
'
Fee summary Charged
Paid
-- Credited
-
Due
r'
--- -- - -----------
Permit Fee Total 72.00 --
-------
.00` --- - - -
-
.00 ---
-- -
72.00 y -
Plan:, Check Total .00
.00
.00'
A:0
Grand Total 72.00
-.00. ..00
'72.00 `
LQPERMTT .