06-4336 (BLCK)T4h
4-
P.O. BOX 1504 ^' VOICE (760) 777-7012'
78-495 CALLE TAMPICO �' F FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
''BUILDING PERMIT
• Date: 12/21/06
Application Number:' ..06-00004336 �. Owner:
'Property Address: 61643- TOPAZ DR SHEA LA QUINTA
APN: 764-.280-999-22 -300237.- C/O JEFF MCQUEEN
Application description: WALL/FENCE 8800 N GAINEY CENTER 350
Y Property Zoning: MEDIUM HIGH DENSITY RES �SCOTTSDALE, AZ 85258 D p
Application valuation: 3130 I ,
Contractor: JAW 0 5 2001
Applicant:- Architect or Engineer: SHEA HOMES, INC
81260.AVENUE 62
LA QUINTA, CA 92253. CITY OF LA QUINTA
(760) 777-6005 FINANCE DEPT.
,} l Lic. No.: 672285 ,
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 the ine s and Professionals 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 C ss: B. License No.: 672285 - _ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is _
issued.
ate: Factor: - - -•� 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are: -
I hereby affirm under penalty of perjury that I am exempt fromtheContractor'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 he work for which this permit is issued, Fshall not employ any -
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the r person in any ma r so as to,c e subje t 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 and agree at, i bec e s ject 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 he Labor e, 1 sh forth it 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 ($5001.:_ - _ ate:J
(-) 1, 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: FAIL RE 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 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
1 _) 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.). - 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 Ouinta, 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 thisapplicationbecomes null and void if work.is not commenced -
- within 180 days from date of issuance of such permit, or cessation ofworkfor 180 days will subject -
CONSTRUCTION LENDING AGENCY permit to cancellation. -
�;,+ r .I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the - I certify that I have read this application and state that a ove i form�nn
's cone t. 1 agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). - city and coup ordinances and state laws relati o b in con ructid here authorize representatives P n men p insP c000ses.
..-of th' u¢ty. o�IIter u o thea ove- do d rope y
Lender's Name:
Qi; - ate: Si ure (Applicant or e `
Lender's Address: r' - -
LQPERNIIT
Application Number . . . 06-00004336
Permit . . . WALL/FENCE
PERMIT
Additional desc ...
Permit Fee 63.00
Plan Check
Fee
00
Issue Date . . . .
Valuation
. . .
. 3130.
-Expiration Date 6/19/07
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.
.90 L.F. 61GARDEN 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