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04-7956 (BLCK)i= ' T4hf 4 4 a" . ` BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 Application Number Property Address . . . APN Application description Property Zoning . . . . Application valuation . BUILDING PERMIT , 0}�0'0'_QQ aW 'Date 12/30/04 �6 F� l3 KATIE CIR 764-270-999-161 -300233- . . WALL/FENCE . . MEDIUM HIGH DENSITY RES 5920 Owner Contractor --------------------------------- --------------------- ----------- SHEA LA QUINTA SHEA HOMES, INC. C/O JEFF MCQUEEN 81260 AVENUE 62 8800 N GAINEY CENTER 350 LA QUINTA, CA 92253 SCOTTSDALE, AZ 85258 (760)777-6005 WCC:. NTL UNION INS WC: 6436568 08/01/05 CSLB: 672285 06/30/05 CCC: B ----------------------------------------------------------------------------- D �Q J 3.1005 CITY OF LA QUINTA FINANCE DEPT. 4 P.O. Box 1504 • /:. w VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 04- - % q 5% Date: Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: Lic. No.. N l� BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under ty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my LicensIl force and effect. cense CI ss I ^ License No. ate rector /r OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I 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 ($500).): 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 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.). U I am exempt under Sec. , B.& P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 37CO of the Labor Code, for the performance of the work for which this permit is issued. I ha a d will aintain workers' mpens ' n insuragce, as required �y Sectio 3700 of the Labor Code, for the performance of the work for which this permit is My w rke ' compen o 1 urance carie♦ and poti�Orrbe, Carrier icy Number l.e l'[ S�ll7 1 _ I certify that, in the performance of the work for whi 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 that, I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with thos i DateppliA ca 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. 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 permit. 2. Any permit issued as a result of this application becomes null and void if wo 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 ct I agree to comply with all city and county ordinances and state laws relating to building ;Dos ntesentatives of this couna er upon the a v - roperty for inspection purposes. ate Signature (Applicant or Ag64�- - - - - - - - - - - - - - - - - - - - - - - - - - - - - t - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - �:°.. Application Number %,; `00007956 ---------------------------------------------------------------------------- ' Permit . . . . WALL/FENCE PERMIT Additional desc . . Permit Fee . . . ' 81.00 Plan Check Fee .00 Issue Date . . . . Valuation 5920 Qty Unit Charge Per Extension BASE FEE 45.00 4.00 9.0000 THOU BLDG ---------------------------------------------------------------------------- 2,001-25,000 36.00 Special Notes and Comments 160 L.F. 6' GARDEN WALL, 120 L.F. 3' RETAINING WALL, BOTH ORCO SYSTEM Fee summary, Charged Paid Credited Due ------------------------------------- Permit Fee Total 81.00 ---------- .00 ---------- .00 81.00 Plan Check Total .00 .00 .00 .00 Grand Total 81.00 .00 .00 81.00