04-4933 (BLCK)'ot
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504. (760)" 777-7012-
7 8 -495
77-701278-495 CALLE TAMPICO FAX (76 0) 777-7011
SLA-QUINTA., CALIFORNIA 92253 INSPECTION REQUESTS (760).777-7153. .
BUILDING PERMIT
J Application Number . . .
04-00004933 Date 6/16/04.
Propert;y;M1,Address . .
81266 STONE CROP LN
Ap.N.
764-270.-999-83 -300233-
Application'description'.,
WALL/FENCE
Property Zoning -.
MEDIUM HIGH DENSITY RES.
.'Application valuation "..
85S5.
Owner
Contractor
- - - - -------- .------ - - - - --
SHEA,LA QUINTA
....-- .s ------y-------------
SHEA HOMES,' INC.
C/O JEFF.MCQUEEN
81260 AVENUE .62
8800 N GAINEY.. CENTER- 350 ••
LA .QUINTA
CA --92253
SCOTTSDALE A.Z.85258
(760) 777-6005
WCC: NTL UNION
.INS .
:..
WC. 7.165833
08/01/04
CSLB::. 672285."
06/30/05 .
CCC:. B
Permit . ... . . . WALL/FENCE
PERMIT
...Additional desc
Permit Fee 108.00
Plan Check Fee"
.00
Issue Date
Valuatioli...
.8555
Qty Unit -Charge.: Per
Extension
BASE
FEE',�:;
:
7.00: 9.0000 THOU BLDG
:2;.001=25, 000
..45.00
" `''r `''a 63.00
\
Special Notes and Comments
243 LF 61GARDEN WALL ORCO STND
155 LF 3' RETAINING WALL ORCO STND°
w
Fee summary ..,,.Charged
Paid Credited
Due.
Permit Fee Total" 10:8..00
.00 .00
108.00
Plan Check Total 00
00 :00
..00
Grand Total 108.00
.00. .00
108.00
P.O. BOX 1504 VOICE •(.760) 777-7012.
78-495 CALLS TAMPICo FA -X-(760)777-7011'.
LA QUINTA, CALIFORNIA 922.53 INSPECTIONS (760)'.777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Yl 33 I Date: &- a a= rxl
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's d e
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of pedury that l am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
'Code, and my Usurns in full force and effect. I — �[,�
License Class D �L
License No. _)9� rD V
Date to 'la f ConUactor_ c ��LIS^
OWNER -BUILDER DECLARATION
I hereby affirm'under penalty of perjury that 1 am exempt from the Contractors' State License Law for the.following.reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant for the permit to file a signed .
statement that he or she Is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or.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.):
U 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 Contractors' State License Law. does not apply to an owner of property who builds or Improves thereon, and.who does the work
himself or herself or through his or her own employees, provided that the improvements are not Intended or offered for sale. If, however; the building or improvement is
sold within 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.).
U I, as owner of the property, am exclusively contracting with licensed contractors to constrict the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for the projects with a contractors) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION, DECLARATION
hereby affirm under penalty of perjury one of the following declarations:.
_ I have and will maintain a certificate of consent to self4nsure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is Issued.
I ve a ill maintain wo Ors'compensation Insurance, as required*bSection 3700 of the Labor Code, for the performance of the work for which.this permit is
1 sue` rsco nsation Insurance a rAererld�
Carrier 1 � Policy Number `
_ 1 certify that, in the performance of the work for w this permit is Issued. I shall not employ.any person in any manner so as to. become subject to the workers' .
compensation laws of California, and agree t t, I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
' n forthwith comply with those p ovisio
Date P, L6�Z ApPliran
WARNING: FAILURE TO SECURE WO ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR'CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there Is a construction lending agency for the performance of the work for which this permit is Issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made; each person at whose request and for whose benefit work is performed under or pursuant to any Permit
issued as a result of this application, 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 penniL
2. Any permit Issued as a result of this application bec?,mes null and void if ork is not commenced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information Is co I agree to comply with all city and county ordinances and state laws relating to building en
constructio , and he by authorize representatives of this county t% r upon bov(ee-('mi ntiioneedd property for inspection purposes.
Date Q Signature (Applicant or Agent). — " —