06-2691 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO'
LA QUINTA, CALIFORNIA 92253
T4'y,,, 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: ' 7/17/06
Application Number: 06-00002691 Owner:
Property Address: 61216 TOPAZ DR SHEA LA QUINTA
APN:. 764-280-999-159 -300237- C/O JEFF MCQUEEN
Application description: WALL/FENCE 8800 N GAINEY CENTER 350
Property Zoning: MEDIUM HIGH DENSITY RES SCOTTSDALE, AZ 85258
Application valuation: 2873
Contractor:
Applicant: Architect or Engineer: SHEA HOMES, INC. D a
81260 AVENUE 62 [i=�
LA QUINTA, CA Q2253
aG� ic. o.: 672 JUL -20,2006 .
Lic. No.: 672285
CITY OF LA QUINTA
FINANCE DEPT.
LICENSED CONTRACTOR'S DECLARATION
I here y affil under penalty of perjury tha I am licensed under provisions of Chapter 9 (commencing with
c 7000 of Division 3 of the B s ss and Professional de, and my License is in full force and effect.
Lce las B seNo.: 672285
Dace: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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 sale 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 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:
LQPERAIIT
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.
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 workerscompensation
insurance carrier and policy number are:
Carrier AMERICAN HOME A Policy Number 1247619 \
_ I certify that, in the perfor nce of the work for which this permit is issued, I shall not employ any
person in any manner so s to ecome ubject to the worke ' compensation laws of California,
d agree that, ine s t to the workers' c pensation provisions of Section
/Iy/�►700 of the aborth comply with th rovisions.
atD e: 1 pplicantr
i_
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 Quinta, its officers, agents and employeesforany 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 uch permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify at I ha read this application and state that a informK'on' s correct. I agree to mply with all
city ounty or finances and state laws relati o ding c nstructnd hereby authorize asematives
o�hicer upon the above -mention d prop rt r' spectioposes.
D Si ture (Applicant or A
Application Number . . . . . 06-00002691
Permit . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee 54.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 2873
Expiration Date 1/13/07
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
90 L.F. 6' GARDEN WALL & 78 L.F.4'
KNEE
WALL, ALL 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