08-0215 (BLCK)FAM
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
08-00000215 ,
Property Address:
61419 SAPPHIRE LN
1
APN:
76.4-280-999-104 -300236'-
Application description:
WALL/FENCE
Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
2455
ADDlicant:
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engine
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' LICENSED CONTRACTOR'S DECLARATION
I here y affi m de pe ally of perju th t 1 am licens under provisions of Chapter 9 (commencing with
Sectio .700 1 f n 3 of the Bu ' and Prof s rials Code, and my License is in full force and effect.
Li s las : WcenseNo.: 672285
ontractor:
OWNER -BUILDER DECLARATION
I hereby ffirm 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 ($500).:
1 _ 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, 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.).
1 _ 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:
LQPER-MIT
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) 777-701.2
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/30/08
--1------------------------------1---------------
WORKER'S COMPENSATION DECLARATION'
I hereby 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
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 and policy number are:
Carrier AMERICAN HOME ft Policy Number C 1593364
I certify that, in the perfor ance of the work for whic his permit is issued, I shall not employ any
person in any manner o eco subject to t workers' compensation laws of California,
and agree that, if I ou d b o e bj ctj.to� kers' compensation provisions of Section
�I�3�00 of the Labor Cod , I sha o wi ►Com ly itGPose provisions.
(31 k _ r
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE 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 Ouinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance this permit.
2. Any permit issued as a result of this ap I anon becomes null and void if ork is not commenced
within 180 days from date of issuanc such permit, or cessation of ork for 180 days will subject
per it to cancellation.
I certify hat I h ve read this application and s to th the ab ve in tion is co ect. I agree to comply with all
ci nd unty rd' ances and state laws rel ting t build; cost cti n, nd uthorize representatives
o t t •t on the above -men o ed operty f insp do p rpo
ate: i ature (Applicant or gent):
LQPER.r,IIT
Application Number . . . 08-00000215
Permit ..- . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 54.00 Plan Check Fee -
00
Issue Date . . . . Valuation
2455
Expiration Date 7/28/08
Qty Unit Charge Per
Extension
BASE FEE
45.00
.1.00 9.0000 THOU -BLDG 2,001-25,000
9.00
Special Notes and Comments
95 L.F. COMBO WALL, 3' RETAINING, 6'.
GARDEN & 5 L.F. 3' RETAINING WALL,.BOTH
ORCO SYSTEM
-
Fee summary Charged Paid Credited
Due
Permit Fee Total 54.00 .00 .00
54.00
Plan Check Total .00 .00 .00
.00
Grand Total 54.00 .00 .00
54.00
LQPER.r,IIT