05-5307 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application NUmbe : 05-00005307 /
Property Address: 81761 ULRICH DR
APN: 764-270-999-81 -300234- '.
Application description: WALL/FENCE
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 2870
Applicant:
T4tyl 4.4 Q"
Architect or Engineer:
P / P
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SHEA LA QUINTA
DLL C/O JEFF MCQUEEN
G�, 1' "qq 8800 N GAINEY CENTER 350
tr'1VJ
Ir
SCOTTSDALE, AZ 85258
CIT11 OF LA QUINTA
FINANCE DEPT.
Contractor:
SHEA HOMES, INC.
81260 AVENUE 62
LA QUINTA, CA 92253
(760)777-6005
Lic. No.: 672285.
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/08/05
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LICENSED CONTRACTOR'S DECLARATION
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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 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 Class: 13 License No.: 672285
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
ate: ntractor:
issued.
I 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
and agree that, if Iould becomes ject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
700 of the Labor d hall fo ith comply with 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).:
A n
(_ 1 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.).
(_) 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 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
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 personat whose request and foe
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 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 cessation of work for 180 days will subject
permit tocancellation.
I certify that I have read this application and state that the above informatio correct. I agree to comply with all
city and county ordinances and state laws relating tolldingnstructionhereby authorize representatives
of this cou t t enter upon the above-mentionedspectpplicant or Agent
Application Number . . . 05-00005307
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee. 54.00
Plan Check
Fee
.00
Issue Date
Valuation
.
. 2870
Expiration Date 6/03/06
Qty Unit Charge Per
Extension
BASE FEE
45..00
1.00 .9.0000 THOU BLDG 2,001-25,000
9.00
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Special Notes and Comments
70 L.F. .6' GARDEN WALL, 70. L.F. 3'
RETAINING WALL, BOTH ORCO-SYSTEM, PER
.PLANS APPROVED P/W & C/D
Fee summary Charged Paid
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Credited
--------------------
Due
Permit Fee Total 54.00
.00
.00
54.00-
4.00Plan
PlanCheck Total .00
.00
.00
.00
Grand Total 54.00
.00
.00
54:00
LQPERMIT