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04-4462 (BLCK)1. Box 1504 495 CALLE TAMPICO QUINTA, CALIFORNIA 92253 mber ss APN: Application description Property Zoning Application valuation BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 1 .---04-000*04A62-7 Date 5/21/04 .�-60519JLACE LEAF CT 764-270-999-113-300231- WALL/FENCE MEDIUM HIGH DENSITY RES 11275 Owner -------------------------- SHEA LA QUINTA C/O JEFF MCQUEEN 8800 N GAINEY CENTER 350 SCOTTSDALE AZ 85258 Contractor SHEA HOMES, INC. 81260 AVENUE 62 LA QUINTA CA 92253 (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 . . . 135.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 11275 Qty Unit Charge Per Extension BASE FEE 45.00. 10.00 9.0000 THOU BLDG 2,001-25,000 90.00 ---------------------------------------------------------------------------- Special Notes and'Comments 275 L.F. 6' GARDEN WALL, 275'L.F. 3' RETAINING WALL, BOTH ORCO SYSTEM Fee summary -------------- Permit Fee Total Plan Check Total Grand Total Charged Paid 135.00 .00 .00 ..00 135.00 .00 Credited Due ,00 135.00 .00 .00 .00 135.00 P.O. BOX 1504 a//�� 78-495 CALLE TAMPICO Ilj� VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 44FAX (760) 777-7011 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: - & a� Applicant: Date:Architect or Engineer: Appiicant's Mailing Address: Arcrntect or tngineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty 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 License is in full force and effect. License Class � License No. Dateontractor OWNER43UILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State Ucense 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 fo statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Sectir the permit to file a signed on 7000) o 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 io 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. . 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 and will maintain workers' compensation insurance, as required b Section 3700 of the Labor Code, for the performance of the work for which this issued. M workers' com ensation i q y permit is Y P SurarCe carrier and policy number are: wrier '—Policy Number I certify that, in the performance of the work for which 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, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date_ /%►oolic nt WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 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 r IMPORTANT Application is hereby made to the Director of Buildingand Safety for ACKNOWLEDGEMENT h on this appi 1. Each person upon whose behalf this application is made, each person at whose reqPermit uest st and for hose benefit work sct to the condifions andnperfo setfm rtad under or pulrca ion. suant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City of Le 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 i cessation of work for 180 days will subject permit to cancellation. ssuance of such permit or I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. ateSignature (Applicant or Agent):