05-1854 (BLCK)'r
P.O. BOX 1504
78=495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
�05�;j5E 0 85
Property Address:
81226 SANTA ROSA CT
APN:
764 -270 -999 -20 -300234 -
Application description:
WALL/FENCE'
Property Zoning:
MEDIUM ' HIGH DENSITY RES
AppDcation valuation:.,
50.00
Applicant: Architect or Engineer:
., -LICENSED CONTRACTOR'S'DECLARATION
4
BUILDING & SAFETY DEPARTMENT
BUILDING -PERMIT
Owner:
Dn SHEA LA QUINTA
[� C/O JEFF MCQUEEN
8800 N GAINEY'CENTER 350
1111 0 3.:200 i SCOTTSDALE, AZ 85258
JUN , . 6
CITY OF Q 1N Contractor:
FIN%1NCE ®IEP.T. SHEA HOMES, INC.
81260 AVENUE 62
LA QUINTA, CA 92253
(760,)777-6005
Lic. No.: 672285
I hereby. affirm under penalty of perjury that I am licensed under -provisions of Chapter 9 (commencing with
Sectioni7000) of Division 3 of, the Business end Professionals Code; and my License is in full force and effect.
Licensee CI'ss::-;B - License No.: 672285
ate /rD 0 ontractor.
OWNER -BUILDER DECLARATION.
I hereby.affirm under rpenalty ofperjury that I amexempt-from the Cdntractor's'State License LAV,for the -
following reason (Sec., 7031.5, Businessand Professions Code: Any city or county that requires a permit to
construct, alter, improve,demolish,.orrepair'any 0ructure,.phor to its issuance, also requires the applicant for the
permit to file assigned statement that he or sh.a is�licensed pursuant to the provisions of the Contractor's State
License'Law '(Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption., Any violation of Section 7031.5 by
any applicant fora permit subjects the applicant to.a civil: penaltyof not more than five hundred, dollars ($500).:
1—) 1, as owner of the property, or my,empioyees with wages as theirsole'compensation will do the work, and /
�;�thestructure is'notintended orofferedfonsalelSecc.Z044 Business and.Professions Code: The
.'.'Contractors' State_ License Law.does.not'apply town.o�dner of property -who buildsor,improves thereon,
w,. and who does the work himself or,herself through:his of her own employees, provided that the
improvements are not int endaa: offered for sale.; If, however, the building or improvement issoldwithin
one �yearof completion, the owner -builder will have the burden of�proving that he or she did not build or
improve for the purpose -of sale.).'` _
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: - The Contractors'. State {icense.Law' does not apply to an owner of
property who builds or improves thereon, and who contracts for the.projects with a contra'ctor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. ', B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING 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:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/24/05
--------------------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby: affirm under penalty of perjury one of-th*a following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work .forwhich this permit is
issued.
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
insurance carrier andpolicynumber 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
personin any manner so'as to become subject to the workers' compensation laws of California,
and agree that,-if.l should become subject to the workers' compensation provisions of Section
3700 of the Labor Coddee shall fo�.wiithh comply with those. provisions.-
ap
. ate: plic'an t: �l,/(Q%� Qfr�Tid+
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION -COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT'AN EMPLOYER70 CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED. THOUSAND
DOLLARS (S100',000). 1N ADDITION TO THE.COST OF COMPENSATION_ DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE „INTEREST; AND ATTORNEY'S FEES.
APPUCANT;ACKNOWLEDGEMENT
IMPORTANT Applicatiori is hereby made to theDirector of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person -upon whose. behalf this application is made, each person at whose request and for
Whose benefit 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 Ouinta, 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 app) cation'becomes null and void ifwork 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 application and state that the above information is'correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upo the above-mentioned property for i pection purposes
.-Mte: ignature (Applicant or Agent):
LQPERMIT
Application Number 05-00001854
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 72.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 5000
_
Expiration Date 11/20/05
Qty Unit Charge Per
Extension
BASE -FEE
45.00 '
' 3..00 9•.0000- THOU BLDG 2.',-001-2.5-,•000
"
21. 00
., _.. •l `d C ;-. - - - - - -------
.Speci'aNotes anonmerits
- ------
- - -
2 OjO_ L. F .,"6 'GARDEN'' WALL ; ORCO`= SYSTEM
Fee summary. Charged Paid Credited
------------- ------------
Due
----------- ----------
Permit, Fee Total - 72.00 ," 00
----.-----
.00:
72.00.
Plan Check Total 00 .00;
.00
•.:00
Grand Total 72.00. 0:0
00
72".00
LQPERMIT