05-1838 (BLCK). , T i , (f 4
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) 777-7153
BUILDING PERMIT
I -
Date: 5/24/05
Application Number: �0'5=000.0"1838'`"'� Owner:
Property Address: 8.12-0"7 SANTA ROSA CT a SHEA LA QUINTA
APN: 764-270-999-28 -300234- DC/O JEFF MCQUEEN
Application description: WALL/FENCE 8800 N GAINEY CENTER 350
Property Zoning: MEDIUM HIGH DENSITY RES SCOTTSDALE, ' AZ 85258
Application valuation: 5125 JU.IV 03 2005 -
CITY OFLAQUINTA Contractor:
Applicant: Architect or Engineer: FINANCE. EPT SHEA 'HOMES, INC.
8126.0•,.AVENUE 62
LA QUINTA,CA 92253
(760)777-6005
fi. I Lic. No.:.67228.5
-=----==---------------- ------ - - - - -- ----------------------------------------------------
' r . LICENSED CONTRACTOR'S. DECLARATION. - WORKER'S -COM PENSATIONy DECLARATION -
i• 'I heieby affirm under penalty of perjury that I am licensed under provisions of Chapter'9 (commencing with I hereby affirm under, penalty of perjury one of the following. declare ions:: ,.
Section 7000).of Division 3 of. the Business and Professionals Code and my License is in full force and effect.- ..I have aii will maintain a certificate of consent to selfline fo
sUrr workers"compensation, as provided'
-e
Gcense:C s .8'', t• ..::.' License No.: `672�285�� „' '"'for by Section 3700 of theLabor Code; -,for the performance'of thewark for which this permit is
- issued. ' ^c
,Bate tractor: - t L Y` 'i : " -6 have and. will maintain workers: Compensation insurance, as required by Section. 3700 of the Labor
Code; for the performance of the work for whichthis permit is issued. My workers'. compensation
+!• +a .''
OWNER-BUILDER DECLARATION a . - ~• insurance:caTrier and:
policynumber are:
hereby.affirm under penalty of peryury that) anti exempt from ilie Confractor's State License Law for. the - Carrier NTL 'UNION INS " Policy Number . 6436568"' '
followin reason (Sec_,7D31:5, Busmess'and'Professions-Code: An cit or count that requires a' permit to _ I certify-that, in the erformance of theiwork for which this, ermit is issued, I;shall not employ, an
';. 9 ,., Y Y Y q P. P P P Y; Y
construct; alter,-improve, demolish, or,repairrany'structure,.priorto'its issuance,�also requires: the'applicant-for the person�ih any.m'anner so as to becoine.$ubject [o the.workers',compensaiion laws of California,
permit-to4ile a signed statement that. he or she is licensed.pursuant•to the provisions of 'the Contractor's State and agree that, if I should become subject to the workers", compensation provisions of Section
t License�Law (Chapter &(commencing with-Section7000) of Division 3 of the'Business and Professions Code) or - 3700 of the LaborCode, I shallfoithwith comply with those.provisions.
that he or:she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by / �!
• any applicant for apermit-subjects the applicant to:a civil penalty of not'more than,five hundred dollars.155001.: " C ate: S6tiP- ;A"G\
(— 1 1, as.ownerof-the . property, or`myemployees with wages: as; theirsole compensation will do the work, and W�Policantl:
, i--
the structure�is'not intendedor offered for.saledSec:7044, Business andProfessions,Code: The WARNING: FAILURE-TO SECUREWORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL '
Coniractors' State License Law does notapply.to a.n. wrier of property`who builds or improveathereon, - SUBJECT AN EMPLOYER TO CRIMINAL PEN ALTIES.AND.CIVIL FINES UPTO ONE�HUNDRED:THOUSAND _
and who does the work himself or' Herself through his or, her own employees, provided that the DOLLARS (i:160:606). IN�ADDITION TO THE:COST OF COMPENSATION'.;DAMAGES AS PROVIDED FOR IN.-
improvements arenotintended or offered for sale. If, however, thi'building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, 'AND 'ATTOkNEY'S FEES.
one year of completion, the owner-builder will have the burden of proving that he. or she didnot=build
improve for the purpose.of saletl:: :- _ `" • .r. Y '', ,-APPLICANT ACKNO,WLEDGEMENT� -7 '
(—) I, as owner`of:ihe property, am exclusively contracting with'lici6ed contractors to construct the project,(Sec. IMPORTANT Application is hereby made to the'Director of Building and Safety for a' per it. subject to the
�� - •+'+ ^7044;'Business'and°Professions Code:'The;Gbntractors'StateLicenseLaw does not'applylto'an;owner of ' -'r conditions and restrictiorisae`t'forth on this a "
property, who builds or improves thereod;•and who contracts for the projects with•a contractor(s) licensed 1. Each person upon whose behalf this application. is made, each person at whose request and for
pursuant to the Contractors' State License Law.).`'. whose benefit work is performed under or pursuanrto any permii issued as a result of 'this application,
(_ 1 I am exempt,yr der Seca , B:&P.C.'for this reasonthe owner, anii 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 1Bo 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 I have read this application and state thattheabove information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and staie.laws relating to building construction, and hereb torize representatives
of this county to enter n the above-mentioned property pection purpos
Lender's Name:
ate: Signature (Applicant or Agent).
Lender's Address:
LQPERMIT
LQPERMIT
o
Application Ni.Ii6er 05-00001838
Permit WALL/FENCE PERMIT
Additional desc .
Permit -Fee 81.0.0 _ Plan Check
Fee
.00
Issue Date Valuation
5125
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.
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Special Notes and Comments.
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205-'L.7. 61.GARDEN WALL,ORCO SYSTEM '
Fee summary Charged Paid- Credited.
r--- - ---
Due
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*' Permit Fee Total 81.0000
-
OV81:.00
- --
_ .Plan'Check Total .0'0 :00
.00
..0.0
Grand - Total 81.00 .00
.00
81.00,"
LQPERMIT