06-2709 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 06-00002709
Property Address: 61436 TOPAZ DR
APN.: 764-280-999-149 -300237-
Application description: WALL/FENCE
Property Zoning:. MEDIUM HIGH DENSITY RES
Application valuation: 5325
Applicant: Architect or Engineer:
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LICENSED CONTRACTOR'SMECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000). of Division 3 of the Business and Professionals Code, and my License is in full force and effect. .
License Class: B 1License•No.: 672285
te: ntractor.
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 _ 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:
LQPERMIT'
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER
SCOT TSDALE, AZ 85258
Contractor:
SHEA HOMES, INC.
81260' AVENUE 62
LA QUINTA, CA 92253
(760)777-6005
Lic. No.: 6722.85
VOICE (760) 777-7012
FAX (760) 777-701'1
INSPECTIONS (760) 777-7153
Date: 7/17/06
ID Q �
JUL 20 2006
CITY OF 1A QUINTA
FINANCE DEPT.
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.
1_1 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 performance of the work for which this permit is issued, I shall not employ any .
person in any manner so as tdbecome subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions.
It -at. : Applicant: '
WARNING: FAILURE'TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UR 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.
APP LICANT 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 for 180 days will subject
permit to cancellation. '
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.' .
te: S' ature (Applicant or Agent):
Application Number 06-00002709
Permit . . WALL/FENCE PERMIT
Additional desc .
Permit .Fee -81.00.
Plan Check
'Fee. .
.00
Issue Date . . . .
Valuation
5325
Expiration Date 1/13/07
Qty Unit Charge Per
Extension
BASE
FEE
45.00
4.00 9.0000 THOU BLDG
2,001-25,000
36.00
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Special Notes and Comments
165 L.F. 61.GARDEN WALL & 75 L.F.4'
KNEE WALL, ALL ORCO SYSTEM
Fee summary Charged
Paid
Credited
Due
Permit Fee Total 81.00
00
00
81.00
Plan Check Total - .00
.00
.00
.00..
Grand Total 81.00
.00
.00
81.00
LQPERMIT