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06-2705 (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:. 06-00002705 61348 TOPAZ DR 764-280-999-153 -300237- WALL/FENCE MEDIUM HIGH DENSITY RES 3165 T-iht 4 4 a" Architect or Engineer: �) l q- BUILDING & SAFETY DEPARTMENT BUILDING PERMIT --------------------------------'------------------ LICENSED CONTRACTOR'S DECLARATION . I hereby a rm and r penalty of perjurY� t t I am licensed un r provisions of Chapter 9 (commencing with Section /77�0 01 of D ision 3 of the lint and Professi�na Code, and my License is in full force and effect. LicensJ Ula s: B A II (�� ense No.: 672285 S� �/JLC!).' :��►�� 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.l. (_ 1 1, as owner of the property, am exclusivelycontractingwith 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: LQPERMIT Owner: SHEA LA QUINTA C/O JEFF MCQUEEN 8800 N GAINEY CENTER 350 SCOTTSDALE, AZ 85258 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/17/06 Contractor: D D I SHEA HOMES, INC. L 81260 AVENUE 62 LA QUINTA, CA 9253 JUL 212006 (760)777-6005 Lic. No.: 672285 CITYQFL.Aomw ----------------------------------------------- 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 I& by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I 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 Number 12A7619 _ I certify that, in the perf mance of the wor for which permit is issued, I shall not employ any person in any manner as become s , ject to the orkers' compensation laws of California, d agree that, if I s e ome ject o the wor s' compensation provisions of Section I the La or o , I II fo h ith omply w isions. ate: ican WARNING: FAILURE TO SECU ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$100,0001. 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 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 r 180 days will subject p rmit to cancellation. ' I rt y that I ave read this application and state that above inf mation is correct. agree to comply with all t d count ordinances and state laws relatin onstr tion, and ere rize representatives f i n obi upon th above -mention propa forinspe n purp S. e: S ature (Applicant or Ag Application Number . . . . . 06-00002705 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee 63.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 3165 Expiration Date 1/13/07 Qty Unit Charge Per Extension BASE FEE 45.00 2.00 9.0000 THOU BLDG 2,001-25,000 18.00 ---------------------------------------------------------------------------- Special Notes and Comments 85 L.F. 6' GARDEN WALL & 65 L.F.4' KNEE WALL, ALL ORCO SYSTEM Fee summary Charged Paid Credited Due ------------------------------------- Permit Fee Total 63.00 --------- .00 ---------- .00 63.00 Plan Check Total .00 .00 .00 .00 Grand Total 63.00 .00 .00 63.00 t LQPERD7IT