06-2701 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
06-00002701
Property Address:
61427 TOPAZ DR
APN:
764-280-999-13 -300237-
Application description:
WALL/FENCE -
Property Zoning:
MEDIUM HIGH DENSITY .RES
Application valuation:
3085
c&ht 4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
I hereby a, irm rider penalty of perjur that I am licen ed under provisions of Chapter 9 (commencing with -
Sectio 7 01 Di isiori 3 of the ess and Pr fe ionals Code, and my License is in full force and effect.
Licens I ss: ' License No.: 672285
ate: ontracto
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
improvefor 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.).
I _ 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:
LQPERA11T
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350
SCOTTSDALE, AZ 85258
Contractor:
SHEA HOMES, INC._
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 2 � 2006
CITY
or. LA QUINTA
ANCE DEPT
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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
�1 issued.
VAI 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 1247619
I certify that, in the perform rice of the work for whi this permit is issued, I shall not employ any
person in any man s s to be subject to a workers' compensation laws of California,
^ a d agree that, if I Id ecome subj t to therkers' compensation provisions of Section
I y3�/00 of the lab shall fo hwith gomply ith)those provisions.
WARNING: TO SEC WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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, andtheapplicant, 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 cessatio of work for 180 days will subject
permit to cancellation.
I certify t at 1 hav read this application and stale the t e ve inf rma ion is rrect. I agree to comply with all
Nate
c unty or inances and state laws relating ui nstr 'o an h reby authorize representatives
o t e ter upohe above-mentione rope y fo spe p os
nature (Applicant or A t • r
Application Number . . .'. . 06-00002701
Permit . . . WALL/FENCE
PERMIT
Additional desc . .
Permit Fee . . . . 63.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 3085
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 & 60 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
LQPERMIT