08-0226 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
t
Application Number: .
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
r 08-00000226 Y ,
61455 SAPPHIRE
764-280-999-102
WALL/FENCE
LN
-300236-
MEDIUM HIGH DENSITY RES
4740
Architect or
P 0-
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
LCEN
ED ONTRACTOR'S DECLARATION
1 hereb affirm nder penalty of pe ' r that I am ice sed under provisions of Chapter 9 (commencing with
Sectio 0001 ion 3 of the ness and rtif sionals Code, and my License is in full force and effect.
Li Mass: License No.: 672285
tractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the.
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
.License Law (Chapter 9 (commencing with Section 7000) 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 for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1$5001.:
(_ 1 I, as owner of the property, or my 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 or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
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.).
I _) 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 License Law does not apply to an owner of
property who builds or improves thereon, and who contracts.for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
( ) 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:
LQPERIIIIT
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350
SCOTTSDALE, AZ 85258
Contractor:
SHEA HOMES, INC.
60800 TRILOGY PARKWAY
LA QUINTA, CA 92253
(760)777-6005
LiC. No.: 672285
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/30/08
WORKER'S COMPENSATION DECLARATION
I heieby affirm under penalty of perjury one of the 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 for which this permit is
N issued.
aA 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 and policy number are:
Carrier ERICAN HOME Polic umber CA 1593364
1 certify that, in the performance of the rk for which this permit is issued, I shall not employ any
person in any manner s0 as to beco a ublect to the workers' compensation laws of California,
and agree that, if I st d ecome s bj ct t�q' the workers' compensation provisions of Section
L_ $700 of the Labor C, I hall fort t olnply with those provisions.
WARNING: FXULURE TO SECURE RKE ' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL -
SUBJECT AN EMPLOYER TO CRIMI L PEJIALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001 IN ADDITION TtrIHE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF 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 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 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.
1 certi the I have read this application and state thoildinconstr
ation is correct. I agree to comply with all
C ' cc ty ordinances and state laws relating ton, and hereby authorize representatives
th' pyd 'o enter upon the above-mentioned prn purposes.
e: rl�Jn/' nature (Applicant or Agent):
LQPEPAIIT
Application -Number 08-00000226
Permit . . . . . . WALL/FENCE`PERMIT
-
Additional desc .
Permit Fee 72.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 4740
_ Expiration Date 7/28/08
Qty Unit Charge Per
Extension
BASE FEE'
45.00
3.00 9.0000 THOU BLDG 2,001-25,000
27.00
---------------------------------------------
Special Notes and Comments
95 L.F. COMBO WALL, 3' RETAINING, 6.'
GARDEN, 85 L.F. 6- GARDEN WALL.& 15 L.F.
3' RETAINING WALL, ALL 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
.00
.00
72.00
LQPEPAIIT