06-3987 (BLCK)Qum&
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
-.BUILDING PERMIT
Date: 11/14/06.
-Application Number: 06-00003987 Owner:
Property Address: 61590 TOPAZ DR SHEA LA QUINTA
APN: .•" 764-280-999-142 -300237-CIO C/O JEFF MCQUEEN
Application description: WALL/FENCE 8 N GAINEY CENTER 350
Property Zoning: MEDIUM HIGH DENSITY RES TSDALE, : AZ 85258
Application valuation: 3005 NOV. 202006
Y ractor:
Applicant: Architect or Engineer: CfT1'OF SH A HOMES, INC.
SQUINT
-' FfNANCE pEpr 81 60 AVENUE 62
QUINTA, CA 92253
Iv (760)777=6005
-Lic:-No.: 672285
r
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'LICENSED CONTRACTOR'S -DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions -of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: ,
Section 7000) of Division.3 of th = in ss and Professionals Code, and my License is in full force and effect' _ I have and will maintain acertificate of consent to self -insure for workers' compensation, as provided
License lass: License No.: • 672285 _ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued:
ate: ontract0r _ �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
OWNER -BUILDER DECLARATION insurance carrier and policy number are: r
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier AMERICAN HOME , Policy Number 1247619
following reason (Sec. 7031 .5, Business and Professions Code ' Any city or county thatrequires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any'
_ construct, alter, improve, demolish, or repair any structure, prior to• its issuance, also requires the applicant for the person in any manner as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contiactor's State - and agree that, if I Id be m subject t he workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or .3700 of the r , I sh fo hwith ply with those provisions.
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).: e % pylic - -
(_) 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
- Contractors' State License Law does not apply to an owner of property who builds or improves thereon, -SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does thework himself or herself -through his -or'her own -employees; provided that the' - - - -DOLLARS ($100,000)-. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED, FOR, IN.
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). . ' APPLICANT ACKNOWLEDGEMENT
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety fora permit subjectto the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
.property who builds or improves thereon, and who contracts for the projects with a contractor(s).licensed 1 ., Each person upon whose behalf this applicationismade, each person at whose request and for
pursuant to the Contractors' State License Law.). - whose benefit work is performed under or pursuant to any permit issued as a result of this application, .
(-_ 1 I am exempt under Sec. , B.&P.C: for this reason 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. ^
- Date: - Owner: , 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
CONSTRUCTION LENDING AGENCY permit to cancellation.. -
I hereby affirm under penalty of perjury that there is a'construction lending agency for the performance of the 1 certify that I have read this application and state t the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). ` city and ount ordinances and sea relating t 'n onstruction, and hereby authorize representatives
of this co my t enter upon th ove-mentioned ert f 'nspection purposes. -
Lender's Name: I
i ature (Applicant or A e
Lender's Address:
LQPERA11T -
vr�'a-mss
Application Number . . . . 06-00003.9,87
PermitWALL/FENCE
PERMIT
Additional--"desc .
Permit Fee . . . 63.00
Plan Check
Fee
.00
Issue Date . . -
Valuation
3005
Expiration Date 5/13/07
. Qty Unit Charge Per
Extension
BASE
FEE
45.00
2:00•• •9.0000 THOU BLDG
2,001-25,000
18.00
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Special Notes and Comments
85 L.F. 6' GARDEN WALL & 55 L.F.
41
KNEE WALL, BOTH 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, -
-