05-1852 (BLCK)-01
"'EdY4P.O. BOX 1504 VOICE (760) 777-7012
-,78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING. & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: .5/24/05
Application Number: 05-00001852y Owner:
Property Address: 812-0-2`SANTA ROSA CT D Q SHEA LA .QUINTA
APN: 764-270-999,-22 -300234- IC/O JEFF'MCQUEEN-
Application description: WALL/FENCE `8800 N GAINEY CENTER 350
Property Zoning: MEDIUM' HIGH DENSITY RES JUN 0SCOTTSDALE, AZ 85258
Application valuation: 5200 2"
CIT1Y OF Lq
OF
QUINYq ,
01
DEPT , Coritractor:
Applicant: A,rchitect•`or Engineer:
SHEA ,HOMES, INC.
81'260"'AVENUE. 62 .
LA QUINTA;, CA 92253 s,
(766)177-6-005,
Lic..No.: 672285
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UCENSED-CONTRACTOIi-S DECLARATION =
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{NORKER'S,COMPENSATIONDECLARATION
'I hereby'affirm underpenaltyof. perjury thatl-am hcens&d under provisions of:'Chapter.9 (commencing -with
;-1: hereby :affirftunder penajty;of perjury one of the following declarations:•
• Section'70001 of Division,3 of the Business and Professionals Code, and my License is in full force-and:effect.
1�h6ve,and will maintiin'.a.certificate of'consent to self -insure for workers' compensation, as provided-
' LicenseCl "'s B;�_ o - License No::' 672285`. j
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' ` for bySecnon 3700•of theLab�or Coded.for the performance.ofthe work for which this permit
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,
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]fntractor. %//�i��/�� =
issued. . ; ,
I haye and will maintain workers compensation insurance, as required by Section 3700 of the Labor
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`Cone, for the performance of the`work for which thisspermit is. issued My workers' compensation
OWNER -BUILDER DECLARATION :f
hereby affirm under penalty of perjury that l am exempt from the Contractor'%Stite License Law for the
-• insurance-carrier'and.pohcy,numtierare:=- _
Carrier NTL UNION�,:INS Policy Number 6436568`
following reason (Sec.,7031:5, Business and Professions.Code: Any city"or county that,requires a permit to
_ Iicertify that, in the performance of tKi work-forwhich hispermit is issued, I'shall notemploy any "
construct; alter, improve demolish, or repair any structure prior ib1ts issuance, also requires the applicant for the
permit to'file.a:signed statemen6fiathe or she isdicensed pursuant tb -thei provisions:.& the Contractors State '
_
- person, in,anymanner so as to'becorne subject to the'workers'-compensation laws of California,
. " '.and 'agree that: -if I should become subject to the, workers .compensation provisions of•'Section
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:License Law.(Chapter 9' (commencing with Section•7000) of Division 3 of ttie Busingss and Professions, Code) or
3700'of`the'Labor Code, I snall forthwith comply with'ttiose provisions:
that he or.she is exempttherefrom and therefrand theiasis for the alleged exemption. 74ny'violition oYSection 7031.5 by
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Z-_
/�plicant:
hundred dollais ($500)::
any applicanC for a permit subjects the applicant to a civil. penalty of not more than five; w
(_ 1 I;ro wagesmp
,as'owner of the my
-as�their sole-coensation, ill do the work; and
ate:
r
ecemployees<wrth
the structure is not intended or offered forisale (S`Q044 Business and Professions Code: The
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WARNING: FAILURE TO;SECURE-WORKERS'.COMP.ENSATION.COVERAGEISl1NLAWFWL'AND SHALL': '
Contractors', StateCicense,Law:does not apply to,an owner of property, who;builds`oriinproves thereon,
SUBJECT AN;EMPLOYERTO:CRIMINAL P.ENACTIESAND CIVIL FINES UP TO;ONE HUNDRED THOUSAND
- and who does -the work himself or,herself through his�or. herown'employees, provided that the
DOLLARS"($100,000);`IN ADIDITION N ID
To THE. COST or COMPENSATIO; DAMAGES AS PROVED:FOR IN
improvements are nocintended or offered;forsale 1f, however, the'liuilding or' impro'vementis sold within
SECTION 3706-OF.THE LABOR CODEJINTEREST, AND,ATTORNEY'S FEES:
one yearof completion, the owner -builder will have the:6urde'n of proving that he or she did: not build or
. improve for thepurpose of sale.).APPLICANT
ACKNOWLEDGENIENT_
'1:_ 1 .1, as "owner.of the: property,- am exclusively contracting with licensed contractors to construct the:project (Sec.
IMPORTANT Application•is hereby made to the Diiector of Building and`Safe'ty fora permit subject to the ,.
7044 Business and Professions Code The Contractors' State License Law does not apply to an owner of
conditions. and,restrictionsaet forth on.ttii ' application on: :: .r•+r~.,••;�.c'+ »h% <R+� .• s' +. �.
proper[y�wfio bs o
uildr improvesYtRdreon'ano'c
d-whontractiIoi;the projects with_ a contrictcrIs)licensed =
"1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the •Contractors' State License`LawJ. '
- whose benefit work is performed.under or pursuant toany permit issued as a result of this application,
1 "f I am exempfunder Sec: `, B.&P.C. for this reason
the owner, and the applicant; each'agrees to, and shall defend, indemnify and hold harmless the: City
La'Quinta; its officers; agents and employees for any act or omission related -to the work being
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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.
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- 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.'
1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the " .
I 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 ISec. 3097, Civ. C.). -
city and county ordinances and statelawsrelating to building construction, and hereby authorize representatives
of this cou y to enter upo eabove-mentioned property. for • s ction purpose
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Lender's Name:'
�gnature
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ate: (Applicant or Agent):
Lender's Address:
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LQPERMIT
1n
Application Number 05-00001852
Permit . . . WALL/FENCE.PERMIT
Additional desc .
Permit Fee .81.00
Plan Check
Fee
00
Issue Date . .
Valuation
. . .
. 5200
Expiration Date 11/20/05
Qty Unit Charge Per
Extension
-BASE
FEE
45.00
4..00 9.,0000 THOU BLDG
2,001-25,000
36.00
�s
Special Notes and -,Comments
8.0 L.F. .6 ' GARDEN WALL.,' 200 L.F.
31
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RETAINING WALL, BOTH ORCO SYSTEM
Fee''summary :Charged-
Pard
Credited
-Due
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Permit Fee Total 81y 0.0"
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00
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00
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81 00.".
Plan .Check, -Total 00. ; °.
.00
.00
00' '
Grand Total, 81.00.
Q0
.00
81 00<..
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