06-3988 (BLCK)P:O. BOX 1504 -VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA _QUINTA; CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT M INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/14/06
Application Number: 06-00003988 • . Owner:
Property Address: 61612 TOPAZ DR SHEA LA QUINTA
'APN:, 764-280-999-14.1 --300237- DC/O JEFF MCQUEEN
Application description:. WALL/FENCE 4 800 N GAINEY CENTER 350
Property Zoning: • MEDIUM HIGH DENSITY RES OTTSDALE, AZ 85258
Application valuation: 2755, bttfpy„
6�9 0 q
`oos ontractor:. -
Applicant: Architect or Engineer: G OF L4 HEA HOMES, INC.
PINTA . , 81260 AVENUE 62
LA QUINTA, CA 92253
(760)777-6005.
%a
tic. -No.: 672285
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�- LICENSED CONTRACTOR'S DECLARATION - - WORKER'S COMPENSATION DECLARATION
"I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) o Division 3 of the Business.a d Professio als Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
lice s s: Li ense No.: 672285 for by Section 3700 of the Labor Code, for the, performance of the work for which this permit is
issued.
te:tractor:_� 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:
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 that requires 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 mann r so as to become suN 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 Contractor's State a�gr
eethat, if sh Id beco. bject to a workers' compensation provisions of Section •License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or of the Lab r Cod , I shat towith co ly 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).: Date: ant: ' -
(_ 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
7 - 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 the work 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 for a permit subject to 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 application is made, each person at whose request and for "
pursuant to the Contractors' State License Law.). C whose benefit work is performed under or pursuant to any permit issued as a result of this application, -
(_
I. -I am exempt under Sec. , B.&P.C. for this reasonthe 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.
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify at I ha a read this application and staAnild
ove infor anon is c ect. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.1: - city and Gnty dinances and tate laws relatico ucti n, and r by authorize representatives
oft ' c y to nter upo eabove-mentionor in coon -urpos s.Lender's Name:.. Date ignature (Applicant or Ag
Lender's Address: pt.
LQPERAIIT,
"3a
Application Number. 06-00003988
.Permit . . . . . . WALL/FENCE
PERMIT
-
- - - = Additional desc
Permit Fee . . 54.00
Plan Check
Fee'.
.00
Issue Date.
Valuation
2755
Expiration Date 5/13/07
Qty, Unit Charge Per
Extension.
BASE
FEE-
45.00
1.00 -9.0000 THOU BLDG
2,001-25,000
9.00
Special Notes and Comments
---------------
75 L.F..6- GARDEN•WALL & 55 L.F.
4!
'KNEE WALL, BOTH ORCO SYSTEM
Fee summary Charged
-•----
Paid
Credited
Due
-----------------
Permit.Fee Total 54.00_
.00 -.
.00
54.00
Plan Check Total .00
.00
U.
.00.
Grand Total 54.00
.00
.00
54.00
i
LQPERMIT
-
- -