04-4449 (BLCK)T44f °F 4 Q"
BUILDING & SAFETY DEPARTMENT
P.O. BOX 1504 (760).777-7012
8-495 CALLE TAMPICO FAX (760) 777-7011
LAS QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
V,
BUILDING PERMIT
a(s;sti :
Appt on Number 04-00004449 Date 5/21/04
Prope y'Address . . . . . 60458 LACE LEAF CT
APN: 764-270-999-123 -300231-
Application description . . . WALL/FENCE
Property Zoning . . . . . . . MEDIUM HIGH DENSITY RES
Application valuation. 6355
Owner Contractor
------------------------ ------------------ -'---
SHEA LA QUINTA SHEA HOMES, INC.
C/0 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 Fee90.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 6355
Qty Unit Charge Per Extension
BASE•, FEE' 45.00.
5.00 9.0000 THOU BLDG 2,001725,000 w 45.00
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Special-Notes and -Comments
155 L.F. 6' GARDEN WALL, 155 L.F.. 31. ;
RETAINING WALL, BOTH ORCO SYSTEM
Fee summary Charged Paid
Permit Fee Total 90.00 .00
Plan Check Total 00 .00
Grand Total 90.00 .00
Credited Due
..00 90.00
.00 .00
.00 90.00
P.O. BOX 1504 a
78-495 CALLS TAMPICO VOICE (760) 777-701:
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
Application Number: 0 Zi-� Date:
Applicant: Architect or Engineer:
Applicant's Mailing Address: Architect or Engineer's Address:
Lic. No.
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm u r penalty of perjury that I am licensed under ions of Chapter 9 commen
cing with Section 7000) of Division 3 of the Business and Professionals
e, and my i se in full force and effect. %� p �7
incense Class Li/ cense No `o r A00)— is
/ Datta
OWNER -BUILDER DECLARATION
1 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 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 f 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
of the work for which this permit is issued.
� t ave a d will maintain w ers' compensation insuranc , as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
slue y vaprlkers' cc aG n insur 6e � pq�roq r
�rier /� s o icy Number v
_ I certify that in the performance of the work for whi h is permit is issued, I shall not —employ an
compensation laws of California, and agree that if 1 should become subject to the workers' com person to any manner so as io become subject to the workers'
forthwith comply with those provisionsr 1 pensation provisions of Section 3700 of the Labor Code, 1 shall
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 (S 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 hereby affirm under penaltyof CONSTRUCTION LENDING AGENCY
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 mication
ade, each person at whose request and for whose benefit work is performed under or Pursuant to an
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 Le Quints, �pemnt
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 voi work 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 in ation 's I agree to comply with all city and county ordinances and state laws relating to building
construction and reby authorize representatives of this coun n r u
n boned property for inspection purposes.
Date V nature (Applicant or Agent).