06-0713 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT-
-.BUILDING PERMIT
Application Number: 06'=00000713 Owner:
Property Address: �61:250--SO7APTREE DR SHEA LA QUINTA
APN: 764-280-999-164 -300235 C/O JEFF MCQUEEN
Application description: WALL/FENCE 8800 N GAINEY CENTER 350
Property Zoning: MEDIUM HIGH DENSITY RES SCOTTSDALE, AZ 85258
Application Valuation: 4915 OG ~
�+OL
v ontractor:
Applicant: Architect or Engineer: D 0����P SHEA HOMES, INC.
81260 AVENUE 62
LA QUINTA, CA 92253
(760) 777-6005
(Z/ Lic. No.: 672285
VOICE (760) 777-7012.
FAX (760) 777-7011
INSPECTIONS (760) 777-7153.
Date: 2/16/06
------------------------------------------------------------------------------------------------—
LICENSED CONTRACTOR'S DECLARATION 'WORKER'S COMPENSATION DECLARATION
I hereby ffirm 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 Rivision 3 of the e s and RrofVsionals 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 I License No.: 672285 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
at ractor:I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor 6.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's 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 ($500).:
(_ I 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
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 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.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct 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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
I—) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
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:
LQPERMIT
Code, for the performance of the work for which this permit is issued. My workers compensation
insurance carrier and policy numbtsuct
r are,
Carrier AMERICAN HOME er 1247619
I certify that, in the performance of r which this permit is issued, I shall not employ any
person in any manner o a to bect to the workers' compensation laws of California,
a7a7nd agree that, if I sh comthe workers' compensation provisions of Section
the Labor d all fmply with those provisions.
Ars, e: u� icant:
'
WARNING: FAILURE TO SECURE WORKERS' 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 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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 Ouinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
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 ces ation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state t t bove informa on is correct. I agree to comply with all
city and ounty o mances and state laws relating t ' di
cons
- ' , and hereby authorize representatives
of tyle Q+ r upon the above-mentioned r pert r ins cti urpose .
El'ate: L 1` Sign re (Applicant or A .
-Application Number . . . . . 06-00000713
Permit WALL/FENCE
PERMIT.
Additi6nal desc .
Permit Fee 72-.00
Plan Check
Fee, ."
". 00
Issue Date. . . . .
Valuation
4915
Expiration Date ... 8/15/06
` Qty Unit Charge Per
Extension
BASE
FEE
„ - -_..
- 45'.00--
5-:00-..3.00
.3.009.0.000 THOU ' BLDG
2,001-25;,000
27.00
Special Notes and Comments
155 L.F. 6' GARDEN WALL, 65 L.F.
31,
RETAINING WALL, BOTH ORCO SYSTEM
Fee summary Charged
'
Paid
Credited
Due
- - --
7 ----------- - - - - ------ - - - - ----
Permit -Fee Total 72.00
.00
-
00
--- - - -
72..00
Plan Check Total .00
.00
.00
.00
Grand Total 72.00
.,00
.00
72.00
LQPERMIT