06-4343 (BLCK)P.O. BOX 1504
,78-495 CALLE TAMPICO
LA .QUINTA, CALIFORNIA 92253
Application Number: 1
06-00004343-•
Property Address: "` 61722 TOPAZ DR
APN:
764-.280-999-136 -300237-
Application description:
WALL/FENCE
Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
3085
Applicant:
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350
SCOTTSDALE, AZ 85258
Contractor:
SHEA HOMES, INC. .
81260 AVENUE62
_ LA QUINTA, CA 92253
(760)777-6005
Lic. No.:•672285
FD
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/21/06
ea
--JAN 0 5 2007
CITY OF LA QUINTA .
FINANCE DEPT.
----------------------- - - - - ---------------- - - - - -- - - - --
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION -
Aen
rm un er 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:
0) of ivision 3 of the B s and Profess'on Is Code, and my License is in full force and effect. I have and willmaintain a certificate of consent to self -insure for workers' compensation, as provided
seNo.: 672285 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
�Jissued.
n actor:' L 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 2car.
o �bec�ebject 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 1Aagree totworkers'-compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or �oalco ith 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: A- -
(_) 'l, as owner of the property, or my employees with wages as their sole compensation, will do the work, and 1.11the structure isnot 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 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 1, 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,
(_ 1 Tam 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 Cuinta, 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 180days 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 I certifyhaiYve read this application and stat that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). 'city a ounty r nces and state laws i u dingQcnon, d hereby authorize representatives
Lender's Name of thi' n r pon the above- ntioned ro y forq es. - - --� -
- I te: nature (Applic or A I:
Lender's Address: - % 1
A
LQPERA1IT
Application Number . . . 06-00004343
Permit WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . . 63.00
Plan Check
Fee
:00
Issue Date
Valuation
. . .
. 3085
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
- - - - - ------------
Special Notes.and Comments
85 L.F. 6'GARDEN WALL & 60 L.F.
41 'KNEE
WALL, BOTH'ORCO SYSTEM
Fee summary - Charged---
PaidCredited
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
LQPEk,,11T