06-4345 (BLCK)P.O. BOX 15.04 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:, 12/21/06
Application Number: - -06' 00004345 - Owner:
Property Address: 61766• TOPAZ' DR SHEA LA QUINTA
APN: 764-280-999-134'-300237- C/O JEFF MCQUEEN-
Application description: WALL/FENCE 8800 N-GAINEY CENTER 350
Property Zoning: MEDIUM HIGH DENSITY RES SCOTTSDALE, AZ 85258
Application valuation: 6110
Contractor-
Applicant:
ontractorApplicant: Architect or Engineer: SHEA HOMES, INC.
81260 AVENUE 62 JAN 0 5 �OQ1
LA QUINTA, CP 92253
(760) 777-6005
{`J LiC. No.: 6.72285 CITY OF LA QUINTA
FINANCE DEPT,
-
-----------------------------------------------
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 affirmunder penalty of perjury one of the following declarations: r
Section 7000) of Division 3 of the Business 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
License lass: tB License No.:672285 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
G issued.
ate: V ntractor. �. -91 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 p rformance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repairanystructure, prior to its issuance, also requires the applicant for the person in any s to becom subject to a 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 th , if I o ecom s . ie to the rkers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or II 3700 of th Labor de, hall f hwith om 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: `-' ppli
as owner of the property, or my. employees with wages as their.sole compensation, will do the work, and 0.
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 buildsor 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,
(_ 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 aresult 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 t t 1 have read this application and state that t e above informa o 's correct. gree to comply with all
work for which this permit is issued (Sec. 3097 Civ. C.1. , _ - _ • city and hylaunty o dinances and state laws relatin _ g nstr ction, an hereby t orize representatives
of this c b n the above-menti0 prope y sp on purpo s.
Lender's Name: 1� .
/� igna ure (Applicant -or A e _
Lender's Address:
LQPERMIT .
Application Number \•. . . . . 06-00004345
Permit WALL/FENCE PERMIT:
Additional desc
`Permit Fee 90.00 Plan Check
Fee
f •.00 '
Issue Date . . . Valuation
-.
6110_
_
Expiration Date 6/1.9/07
,
_
Qty Unit Charge Per
Extension °.
•' BASE FEE'
45.00
5.00 9.0000 THOU BLDG -2,001-25, 000
45.00
----------------------------------------------------------------------------
Special Notes and Comments .•
«
105 L.F. COMBO•WALL, 6' GARDEN, 3'
RETAINING,, 90• L.F. 6 -GARDEN WALL &_55
4 !- . KNEE .WALL , -ALL ORCO SYSTEM
-Fee summary Charged. Paid Credited
--------------=----------------------------------'---=---
Due -
t Permit Fee Total 90.00 .00.
.00
•90.00
Plan Check Total •.00 .00
.00
.00
Grand Total 90.00 ..00
:00
90'.001
• LQPERDIIT
- t_ •
- , -