06-2703 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 06-00002703
Property Address: 61304 TOPAZ DR
APN: 764-280-999-155 -300237-
Application description: WALL/FENCE
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 1040
Applicant:
cry'
Tiht 4 4Q".
Architect or Engineer:
PIA
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LI ENSED CONTRACTOR'S DECLARATION
I hereby affi m and r penalty of perjury t t am licensed un er provisions of Chapter 9 (commencing with
Section 700 1 of D visi in: of the Busi es a d Professi nal Code, and my License is in full force and effect.
Licens as i ense No.: 672285
e: tractor:
OWNER -BUILDER DECLARATION
I hereby affirm 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 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.). '
(_ 1 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
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350
SCOTTSDALE, AZ 85258
Contractor: n
SHEA HOMES, INC. �J
81260 AVENUE 62
LA QUINTA, CA 92253
(760)777-6005
LiC. No.: 672285
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/17/06
JUL 212006
CITY OF LA QUINTA
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.
ILI 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 Policy mber 12 7619
certify that, in the pert rmance of the for which t s permit is issued, I shall not employ any
erson in any marine
so as be
co bill t to the orkers' compensation laws of California,
agree that, if I sh ome s ct to the wo co pensatian provisions of Section
t� I Olof the Labor e. s all,fort h co of os&OVisions.
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 employees for any act or -omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result 6f this application becomes null and void if work is not commenced.
within 180 days from date of issuance such permit, ar cessLvok for 180 days will subject
permit to cancellation.I certify at I ave read this application and state th thea ove' far anoI agree to comply with all
city duntodinances and state laws relatin o - di co ructiuthorize representatives
ofV9iy Vupon he above -mention pr ert rnsoon
e (Applicant or A
Application Number ... . . . 06-0.0002703
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 27.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 1040
Expiration.Date 1/13/07
Qty Unit Charge Per
Extension
BASE
FEE
15.00
6.00 2.0000 HND BLDG
501-2,000
12.00
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Special Notes and Comments
-
---------------
65 L.F.4' KNEE WALL,ORCO SYSTEM
Fee summary Charged
-------------------------------------
Paid Credited
--------------_-----
Due
Permit Fie Total 27..00
.00
.00
27.00
Plan Check Total .00
.00
.00
.00
Grand Total 27.00
.00
.00
27.00
LQPERMIT