04-4453 (BLCK)r
T,Vf 4 4 Q"
BUILDING & SAFETY DEPARTMENT
D. BOX 1504 (760).777-7012
-495 CALLE TAMPICO FAX (760) 777.-7011
QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760)'777-7153
Pp"p-Pi'cation Number . .
Property Address . . .
APN:
Application description
Property Zoning . . . .
Application valuation -
BUILDING PERMIT
. -0.4=-0=0=0 0 44 5 3, Date 5/21/04
. . . 60568 LACE LEAF CT
764-2.70-999-119 -300231-
. . . WALL/FENCE
. . . MEDIUM HIGH DENSITY RES
. 4210
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: 7165833 08/01/04
CSLB: 672285 06/30/05
CCC: B
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Permit . . . . WALL/FENCE PERMIT
Additional desc
Permit Fee . . . . 72.00 Plan Check Fee .00
Issue Date . . . . Valuation . . 4210
Qty Unit Charge Per Extension
BASE FEE_ 45.00
3.00 9.000.0 THOU 'BLDG 2,001-25,000 27.00
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Special Notes and Comments
130 L.F. 6' GARDEN WALL, 60 L.F. 3'
RETAINING WALL, BOTH ORCO SYSTEM
Fee summary Charged
----------------- ----------
Permit Fee Total 72.00
Plan Check Total .00
Grand Total 72.00
Paid Credited Due
---------- ---------- ----------
.00 .00 72.00
.00 .00 .00
.00 .00 72.00
P.O. BOX 1504 � VOICE (760) 777-7012
LA QUINTA, CALIFORNIAFORN92253 4 4
78-495 CALLE O FAX (760) 777-701 1
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: D - 44 53 Date:
Applicant.
Applicant's Mailing Address:
Architect or Engineer:
Arcnitect or Engineer's Address:
Lic. No..
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm undeLrilegLalty 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 Licen II force and effect.tE.J
,—,"rise Class
� w � License No._
Date
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 ($500).):
U 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 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 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
.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
Xof the work for which this permit is issued.
I have ad will maintain work ' cOmpensati n insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
4-AAlissuej. F)WvoirA'com)ms i rancecarrieflrlfaolietrtGh r -.i,.,-
_ I certify that, in the performance of the work for 4i h this ;mit 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 , if 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
trthwith comply with those p visio S.
DateAp
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 3708 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.).
Lenders 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 application.
1. Each person upon whose behalf this application is made, each person at whoseworunder or sa
issued as a result of this application, the owner, and the applicant, each agrees to. d shall, defend,whose
and hold haperformed
ss the City of La pursuant
iitts
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 dayt from date of issuance of such permit or
cessation of work for 180 Gays will subject permit to cancellation.
I certify that I have read this application and state that the above infQfmation is co I agree to comply with all city and county ordinances and state laws relating to building
construcho , anf hereby authorize representatives of this coun7toupon the ve-mentioned property for inspection purposes.
/Date Signature (Applicant or Agent):d �/`�