09-0949 (SPIN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
09-00000949
61016 DESERT ROSE DR
764-270-999-125 -300231-
SPECIAL INSPECTION
MEDIUM HIGH DENSITY RES
100
Architect or Engineer:
0) /14
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACT O R'S DECLARATION
I hereby affi m under penalty of perjury tha I am licensed unp ovisions of Chapter 9 (commencing with
Section 70 ) of Division 3 of the B ' es and Professionals der Co , and my License is in full force and effect.
Lice s a Lie o.: 672285
Dat Cractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's 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).:
(_ 1 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 Cade: 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 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.).
(_ 1
1, 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
( 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
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: \1
Lender's Address: N
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/08/09
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350
SCOTTSDALE, AZ 85258
Contractor:
SHEA HOMES, INC. `1
60800 TRILOGY PARKWAY T 6
LA QUINTA, CA 922531
(760)777-6005
Lic. No.: 672285
WORKER'S 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.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier NTL UNION INS 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 ect to the workers' compensation provisions of Section
700 of the La o; Code, I shall fo[thy6ith comply with those provisions.
"J. � . lican
WARNIN : FAILURE TO SECURE KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINALL 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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety fora 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 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.
MI hav read this application and state t t he above information is correct: I agree to comply with all
my or finances and state laws relatin o buildingconstruction, and hereby authorize representatives
o rte upon the above-mentione property for inspection purposes.
i Lure (Applicant or A
Application Number . . . . . 09-00000949
Permit . .
. SPECIAL INSPECTION
Additional desc .
Permit Fee . . .
. 100.00 Plan Check Fee
.00
Issue Date
9/14/09 Valuation
100
Expiration Date
3/13/10
Qty Unit Charge Per
Extension
BASE FEE
100.00
--------------------------------------------'-------------------------------
Special Notes and
Comments
SPECIAL INSPECTION TO FINAL SFD UNDER
RIVERSIDE COUNTY
PERMIT #BRS023471. t
CHANGE OF CONTRACTOR FEE ASSESSED TO
INSERT SHED. HOMES
INC. AS NEW CONTRACTOR
OF RECORD.
----------------------------------------------------------------------------
-Other Fees. .`. .
. . . . . . CHANGE OF CONTRACTOR
4.50
Fee summary
Charged Paid Credited
Due
-----------------
Permit Fee Total
----------------------------------------
100.00 100.00 .00
.00
Plan Check Total
.00 .00 .00
.00
Other Fee Total
4.50 .00 .00
4.50
Grand Total
104.50 100.00 .00
.4.50
LQPERA11T
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 09-00000949
Property Address: 61016 DESERT ROSE DR
APN: 764-2707999-125 -300231-
Application description: SPECIAL INSPECTION
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 100
Applicant:
Tavl 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 50
SCOTTSDALE, AZ 852581
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/03/09
4 Jog ji
Contractor: `IfyoF� l 4
Ff�IA,
SHEA HOMES LIMITED PARTN DEPT.
Date:
Owner:
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:
LQPERMIT
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 work is not commenced
yhatl
ihin 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
t to cancellation.
I iread this application and state that the above information is correct. I agree to comply with all
c y dinances and state laws relating to b ' i co str tion, and hereby authorize representatives
nter upon the above-mentioned pro rty for i pe ion purposes.
D S' ature (Applicant or Agent):
60800 TRILOGY PKWY
LA QUINTA, CA 92253
(760)777-6032
Lic. Noo..:: 855368
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby firm u er penalty of perjury th t I am licen ed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Sec ' 7 001 of Division 3 of the B e s and Profe i als Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Li
License No.: 855368
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
r
Date:ctor:
W
issued.
�-F have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier NTL UNION INS Policy Number
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ [.certify that, in the performance of the work for which this permit' issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' mpensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I ould b om subject to the wor+ rs' co nsation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor de, I s all rthwith comply
h vi ' s.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
`1I
P
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Da
A scant:
(_) 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
WARN G: FAIL E TO SECURE ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMI L PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS 15100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
APPLICANT ACKNOWLEDGEMENT
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_) I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
Date:
Owner:
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:
LQPERMIT
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 work is not commenced
yhatl
ihin 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
t to cancellation.
I iread this application and state that the above information is correct. I agree to comply with all
c y dinances and state laws relating to b ' i co str tion, and hereby authorize representatives
nter upon the above-mentioned pro rty for i pe ion purposes.
D S' ature (Applicant or Agent):
Application Number . . . . . 09-00000949
Permit . .
. SPECIAL INSPECTION
Additional desc .
Permit Fee
100.00
Plan Check
Fee
.00
Issue Date . .
.
Valuation
. . .
. 100
Expiration Date
3/02/10
Qty. Unit Charge
Per
Extension
BASE FEE
100.00
--------------------------------------------
Special Notes and
Comments
---------------------------------
SPECIAL INSPECTION
TO FINAL SFD UNDER
RIVERSIDE COUNTY PERMIT
#BRS023471.
Fee summary
-----------------
Charged Paid
---------- ----------
Credited
----------
----------
Due
Permit Fee Total
100.00
.00
.00
100.00
Plan Check Total
.00
.00
.00
.00
Grand Total
100.00
.00
.00
100.00
LQPERMIT