07-1149 (BLCK)P.O. BOX 1504.
78-495 CALLE TAMPICO
LA QUINTA, .CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
0 0.0 0.114-9 I
6-1 S78r--TULARE LN .
764-280-999-115 -300237-
WALL/FENCE
MEDIUM HIGH DENSITY RES
2125
T ihf 4 4 Qm,* 261
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350
SCOTTSDALE, AZ 85258
" •Contractor: -
SHEA. HOMES , INC .: -
60800"tk-ILOGY PARKWAY
LA- QUINTA, CA`. 92253
(760)777-6005
Lic- No.: 672285
VOICE (760) 777-7012
FAX (760) 777-7011 ,
INSPECTIONS (760) 777-7153
Date: 4/18/07
s
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION -
I hereby a irm 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 declarations: -
Sect n 7 01 of Division 3 of the Business and P ofessionaI Code, and my Licenses in full force and effect. _-:Lhave and will maintain a certificat6of consent to self -insure for workers' compensation, as provided
B _ _ - .License No.:' 672285 - for by Section 3700: of the labor Code, for theperformance of the work for which this per
mitis '
�. �.issued. _ /'
ate ` •'�r ontractor _ Yt,have.and,wdl maintain workers"compensation insurance as required by Section 3700 of'the Labor (. r
Code,.for the, performance ofthe work fo'r which this permifis issued: My workers'�compensatiorr '
*-;,ti, OWNER -BUILDER DECLARATION ..r insurance carrier and policy number are:-}, - -
I herebyaffirm under penalty -W perjury that I am exempt from the Contractorls State License Law for the Carrier AMERICAN HOME '' Policy. Number .1247619 , L. :
. „'... ,following reason (Sec!77031. 5;',Business-and Professions Code` Any city'or-county'that requires a permit to _ _�Icertify that,in the performance -of the work for which, this permit -is issued,:) shall not employ,any:- -
.. " construct, alter'`�mproveYdemolish, or.rreepair any. structure, prior to its issuance, also.requires the applicant for the
person in ma er so gas -to become subJto'•workers;compensation'lawsof California,
permit tofile a signed"statement thatheocshe is licensed;pursuani totheprovisionsof,tfie 6ontracfor s5tate and°agree that'iEl1 otildaieeo`subject kers'.compensation.provjsions ofSection?LicenseLaw (Chapter? (Commencing. with Section 7000) of Drvision3 of tliejBusmessandProfessions Codel oC - , 3700 of the to 'shally hwi cth those provisions.
'that he or'she iexempt theref'rdm.and.the basis fortlie alleged exemption Anyviolation of -Section 7031:5'by. _- '
'•. any applicant..pr,a the'applicant to a civil penalty, of not -more ;thanfive�hundred dollars IS5001. ` - at pplica \
( 1 I, as ownerof tfie property, or my.employees;wiih wages as their sole' compensation, will do the work, and71
the structure`is not intended or`offered.for sale (Sec. 7044, Business and Professions Code: The WARNING:' FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself, through' his or her own employees, provided that the DOLLARS, 15100;000)., IN, ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended'or offered for sale. If, however, the building or improvement is sold within SECTION 3706 01 THE LABOR CODE; INTEREST, AND ATTORNEY'S FEES. -
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.), - _ - hereby made to the Director of BuilAPPLICANT ACKNOWLEDGEMENT ,,.I q
1 _ 1 I, asowner bf.the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT;Application is ding, and; fora permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of .conditions and restrictions seUfortli on this application. Z, -
f:
property, -who builds or, improves,thereon, and who contracts for.,the, projects with a contractors) licensed - 1.' Each person upon m
whose behalf this application.cscade',.each person at whose request and for -•.'r i-
' pursuant to the Contractors' State License Law.l.•' - ''whose benefit work is performed under or pursuant i6 any permit issued as a`result of this application,
(_) I am exempt under Sec. , B.&P.C. for this reason 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 orfollowing 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,1180 days will subject
.. - CONSTRUCTION LENDING AGENCYpermit to cancellation. - -
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the Ice 'fy that have read this application and gstathat the above informatio r ' I agree to comply with all
work for which this permit is issued ISec. 3097, Civ. C.1. city d coun ordinances and state laws re ' ding nstruction, and authorize representatives
of t i c enter upon the above-mente fo spection purposes'Lender's Name:
D e: ignature (Applicant or
Lender's Address: Ix
LQPERMIT
Application Number . . . . . 07-00001149
Permit . . . .WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 54.00
Plan Check
Fee
:00
Issue Date . . . .
Valuation
. . .
. 2125
Expiration Date 10/15/07
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
85 L.F. 6' GARDEN WALL, 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
LQPERMIT