04-4455 (BLCK)La�
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s
BUILDING & SAFETY DEPARTMENT
1 BOX 1-7-784kd
(760).777-7012
= O
OFi`CA LE
TAMPICO FAX (760) 777-701 1
LA Q,Vrt, TA -;;CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
JUN 0 IOU
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1J, BUILDING PERMIT
Application Number.
.'04-00004455' Date 5/21/04
Property Address . . . .
. . 60612 LACE LEAF CT
APN:
764-270-999-117 -300231-
Application description .
. . WALL/FENCE
Property Zoning . . . .
. . MEDIUM HIGH-DENSITY RES
Application valuation
1875
Owner----- ----------
- _ - -
L Contractor
- - - -.-'- - - - - - - - - - - -
s-
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: 7165833
08/01/04
CSLB: 672285
06/30/05
-----------------------------------------------------------------
CCC: B
-
Permit . . . . . . WALL/FENCE
PERMIT
Additional.desc .
Permit Fee . . . .
43.00 Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 1875
Qty Unit Charge Per
Extension
BASE FEE%
3:. 15.00.
14.00 2.0000 HND
-----------7------------------------------------------------------------
BLDG,•50-1 2,000
28.00
Special Notes and Comments
75 L.F. 6- GARDEN WALL, ORCO
SYSTEM
Fee summary Charged
---------------------------
Paid Credited
Due
Permit Fee Total 43.00
------------------------------
.00 .00'
43.00
Plan Check Total
.00 .00 ..00
.00
Grand.Total. , 43.00
.00 .00
43.00
P.O. BOX 1504
7$-495 CALLE TAMPICD
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
VOICE (760) 777-7012
FAX (760) 777-701 1
INSPECTIONS (760) 777-7153
Date:
Architect or Engineer:
mc;nnect: or tnglneer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under malty 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 Li in full force and effect. 1
/License Class cense No.
ekktcm
t4a,
I herebyaffirm under OWNER -BUILDER DECLARATION
penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec • 7031:5, Business uires the applicant for the permit to file a signed
the applicant to a civil penalty offnot more than five hundred dollars (5and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also req
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commenting with Section 7000) o Division 3 of the Business
and Professions Code) or that 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
(, I, as owner of the property, or my employees with wages as their 500).):
sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7 044,
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.).
(--) I, as owner of the property, am exclusively contracting with licensed contractors t 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 contractors) licensed pursuant to
the Contractors' State License Law.).
V 1 am exempt under Sec. , BA 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 3700 of the Labor Code, for the performance
Of the work for which this reit is issued.
I have an will maintain wo r compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issu d w rkers' com sation ins �ca pylic �u
Cam icy Number (p
_ I certify that, inthe performance of the work for whi t is permit is issued, 1 shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, f I hould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shalt
forthwith comply with those 1tovisiol>rs.
/ Datelelpfic,'n_Jen1-
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.
I herebyaffirm under CONSTRUCTION LENDING AGENCY
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
IMPORTANT APPLICANT ACKNOWLEDGEMENT
Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this a
1. Each person upon whose behalf this application is made, each person at whosework parsuant
issued as a result of this application, the owner• and the applicant, each agrees to. and shall, defend, indemnity and hold harperfomless under
City of La purto suant
any
t
officers, agents and employees for any act or omission related to the work beim
2. Any permit issued as a result of this application becomes null and void if is r otKcormmen�d wiMrnll 0 dayliufrom flats of isance of this suance nuance of such
cessation of work for 180 days will subject permit to Cancellation. permit or
I certify that I ve read this application and state that the above inf tion is co I agree t comply with all city and county ordinances and state Is" relating t building
construct n, a hereby authorize representatives of this county t to yon the
ve-me'ntio'ned property for inspection Purposes.
a e ature (Applicant or Agent): . Vv