07-0856 (BLCK)P.O. BOX 1504 VOICE(760) 760 777-7012
78-495 CALLE'TAMPICO FAX (760) 777-7011
LA QUINTA,.CALIFORNIA 92253 . ` BUILDING & SAFETY DEPARTMENT INSPECTIONS '(760) 777-7153
x r BUILDING PERMIT
Date: 3/22/07
Application Number: �OF7=0000-0856 Owner:
P.roperty'Address: 61678- TORO' -CANYON WY SHEA LA QUINTA -
APN:,764-280-999-86 -3002377 C/O"JEFF MCQUEEN
Application description: WALL/FENCE 8800 N GAINEY CENTER 350 D
Property Zoning: MEDIUM HIGH DENSITY RES SCOTTSDALE, AZ 85258 A
Application valuation:' 3500
Contractor: MAR -3
Applicant: Architect or Engineer: SHEA HOMES, INC.
60800' TRILOGY PARKWAY®�
LA QUINTA, -CA 92253 �`�Ngq�P��u�wi
(760).777-6005 •`"uY �°8�, A
Lic No.: 672285
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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 000) 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
Liclass: •cense No.: 672285 for by Section 3700 of. the Labor Code, for the performance of the work for which this permit is
ft issued.
Date: ontractor: - - 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 manner so 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 Contractor's State nd agree that, if I sho Id become subject to thew rkers' compensation provisions of Section _.
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 700 f the bor all fort it oinply those provisions. that he of she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by L1� �.
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate: Applicant.
( ) 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 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 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 I certify that I have read this application and state that thea a informati is correc I agree to comply with all
work for which this permit is issued.ISec. 3097, Civ. C.1. - city tgadinances and state laws relating to build' structi n, a d hereb uthorize representatives
of thter upon th ve-mentioned prope f r in ecti pur s.Lender's Name• atenature (Applicant or Agent)
Lender's Address: -
LQPERMIT .