07-1153 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA,.CALIFORNIA 92253
Application Number:.
Property Address:
APN: .
Application description
Property -Zoning:
Application valuation:
0 70-0 0 0 1 153
61`63 4` UT LARE LN
76.4.-280-999-111 -300237--
WALL/FENCE
MEDIUM HIGH DENSITY RES
2125
M.
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 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: 4/18/07
E
APR 3 0 2007.
OFA
QUIMTi4
FINANCE DEPT '
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty ofpe' that am licensed under provisions of:,Chapter 9 (commencing, With ,I hereby affirm under' penalty of perjury one of•thefollowing declarations: -
Sec 'on 70 01 of. Division Sof the aPr f 's ioa e; and*my License is in full force and effect. _ I have and -will maintain a certificate of consent to self -ins workers' compensation, as provided
is lig .. ns No .672 for by Section 3700 of the Labor Code, for the, performance of the work for which this permit is '
- issued. - .
e: ntrac I have and will maintain workers' iompensation insurance, as requiredby Section 3700:of the Labor
Code, for the performance of the work for_ which this permit is issued. M'y workers compensation
-+� - > .OWNER-BUILDERDECLARATION - - insurance carrier'and policy number are. -
1 -hereby affirm under penalty of perjury that I'argexempt from the Contractor's State License Law for the Carrier AMER ICAN.*'HOME:., - Policy Number 124.7619
following reason (§66 .3031.5, .5,. Business; and, -Professions Code: Any city.or county that;iequires a.permit to• 'I certdy.that, in the performance of'.the work for which this -permit is!issued, I shall not,employ-any
. -construct, alter; improve; demolish-or,repair=any structure, prior to its issuance also requires the applicant•for the r . person in,any manner so asto. become, subject to the Workers`comp'ensationlaws of California,
permit to file a signed statement that -he or she is licensed pursuanuto the provisions of^ihe Contractor's State -and agree [hat; if Lshould become subject to the rkers' compensation provisions'of Section
License Law (Chapter 9�(commencing with Sechori 7000) of Division'3 of*the Business'anA Professions Code) or. - �, \ 3�Q0 of -the Labor I halffo h h:com ose provisions. :
that he or she is exempt therefrom and the basis for:the, allegeii exemption.• Any violation:of Section 7031.5 by {Jl ,N -
--.any applicantfor a,permrt sutilects the applicant to a;civil'penelty of not more than'five:hundred.dollars ($500).: te:• - - icon '' t•` .+:: -
(_) 1, as owner of3he property; or my:employees wiihwages as their solekompensation will A6 the work, and
the structure is'novinterided or offered for sale'(Sec. 7044,'Business and, Professions,Code: The. f WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,.AND SHALL
Contractors;`State License Law does' not apply to an owner of property who 1 u64ds oriniproves thereon; SUBJECT AN EMPLOYER TO.CRIMINAL PENALTIES AND CIVIL'FINES UP TO ONE.HUNDRED THOUSAND
and who does, the.work himself: or'herselfLthrough his or. her own employees, provided that the DOLLARS_ ($100,000)- IN ADDITION TO THE COST OF COMP,,ENSATION: DAMAGES AS PROVIDED FOR IN
improvements are not int or; offered -for sale. If, however, the building or improvement is sold within ••' SECTION 3706 OF 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.). - - APPLICANT -ACKNOWLEDGEMENT.. -
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. - IMPORTANT Application is hereby made to�the Director of Building and Safety for a permit subject to the
7044, Business and Professions Coder The Contractors' State License Law does not apply to. an owner of-,. conditions and restrictions set forth onthis application.,
property who builds or improves thereon, and who contracts for the projectswith a contractors) licensed t. Each person upon whosebehalfthis application is-made,,each person at whose request and.for
pursuant to the Contractors' State License Law.). - whose benefit work is performed under or'pursuant to 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 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 180 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 that the above 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 state laws relatingto building 'construction, a hereby authorize representatives
o th' ountytenter up eabove-mentioned p fo inspection pur es.
Lender's Name:. - 3J`
ate: ignature (Applicant or AgfntL/ I A- XP
Lender's Address: If`
LQPERMIT- - -
Application Number . . . . 07-00001153
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