07-1157 (BLCK)P:O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 07="00001'1'54':_`. Owner:
Property Address: 61690 TULARE LN SHEA LA QUINTA
APN: 764-280-999-107 -300237- C/O JEFF MCQUEEN
Application description: WALL/FENCE 8800 N GAINEY CENTER 350
Property-Zoningr MEDIUM HIGH,. DENSITY RES SCOTTSDALE, AZ 85258.
Application valuation: 2125.
Contractor.:
Applicant: Architect or, Engineer: SHEA HOMES, INC.
60800 TRILOGY PARKWAY
LA QUINTA; CA 92253
(760)777-6005
Lic. No.: 672285 .,
LICENSED CONTRACTOR'S DECLARATION
I hereby,affir under penalty,of perjury that I am licensed under provisions of .Chapter 9 (commencing with
Secuo 7000 of Division 3 of the -Business and rofessionals Code;'and myLicense is in full force and effect.
t.
s 13 ' Llcense.NO 672285
ate. ontracto . -
t ; ; rOWNER;BUILDER.DECLARATION- '
I hereby affirm.under penalty of�perjury that) amiexempt from,the iCon4ractor's State License Law for the
following reason (Sec: -7031 .6' Business and Professions' Code: Any city or county that'requires a permit to
construct; 'alter, .imp_rove„demolish, or, repair any'siructure, prior to its issuance, also requires the applicant for the
permit to file a signed'statement thathe;or she:is-i6nsed pursuant to the provisions.of the Contractor; s. State „
License Law (Chapter 9 lcommencmg with Section 7000) of Division 3 of the`,Business.and Professions Codel:or,
>
that he Aors.,.he.is exempt therefrom and the basis for the alleged: exempnon tAny violation of Section 7031,.5 by
any applicant fora pe'rm: subjects the applicantto a civil penalty of"not more than five hundred dollars (5500).:
(. ) I,.as owner of the property,.or my employees'with wages as their sole compensation, will do the work, and
the structure is notintendedor offered for. sale (Sec. 7044, Business.'and Professions Code: The
Contractors'State License Law:does not -apply to in owner of property; who builds or improves thereon,
- and wh6. does the work himself or herself through his or tier -own employees,
provided that the
'improvements are notintended or offered for sale.. if, however,:the building`or_improvement is sold within
• the.burden'of'proving that�lie or she did not build or
one year of'completion;, the, owner -builder will.have -
• improve for the purpose of sale.). .
(_ )' I, as ow t ner.of'the property; am exclusively.'oontracting with licensed contra'cfors to construct the project (Sec.
7044, Business and Profess:,Xs Eode: The. Contractors' State License Law does not apply to an owner of
property who builds. or improyes thereon, and who contracts for the projects with a contractors) 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: `try ,
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/18/07
Y
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�6f. the Labor Code, for the performance of the work for which this permit is
issued.3700
" I have and will maintain workers' compensation insurance; as required l y: Section 3700'of the Labor
Code, forahe,performance of thewvork for which this Dermit islssued.. My workers' compensation
jnsurance carrier, and policy number are: - -
Carrier AMERICAN .HOME'. �;^,Policy Number .1247619
I certify that, in th ,performance-ot the work for which.this permit is issued, I shall not employ any
person:in.any manner so as to become subject to the woriers',compensatiori�laws of'California,
and agree that ifhoUld become subje to the workers compensation provisions of Section
3700 of [he L ode I shat orthwit ply with those provisions.
N�t �.P atli
WARNING:, FAILURE TO SECURE WORKERS' COMPENSATIOWCOVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN'EMPLOYER TO CRIMINAL. PENALTIES AND CIVIL•'FINES UP'TO,ONE HUNDRED �THOUSAND
DOLLARS (5100,000)., IN ADDITION TO THE COST•OF COMPENSATION, DAMAGES A$ PROVIDED FOR IN
-SECTION 3706.OF-TH E, LABOR. CODE INTEREST AND ATTORNEY'S FEES'
APPLICANT ACKNOWLEDGEMENT
IMPORTANT ,Application is hereby made to the Director.of Building andSafety.for a permit subject:to'the•ri _
conditions and restrictionsset 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 Quima, its officers, agents and employees for any act or omission related to the work being
p'e`rformed under or following issuanceof this permit.
2. -Any. permit issued as -a result of this' application becomes null and void if work isnot commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
1 ce ify that I have read this application and N
he above informationis correct. I agree to comply with all
it' my ordinances and state laws reilding constructi and hereby authorize representatives
vfsa enter upon the above-mentirt ori' pectin rposes.. -
ate: \ ignature (Applicant or
LQPERMIT
Application Number . . . . . 07-00001157
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
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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