09-0947 (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:
09-00000947
61021 DESERT ROSE DR
764-270-999-134 -300231-
SPECIAL INSPECTION
MEDIUM HIGH DENSITY RES
100
T iht 4 *fP4ld«rw
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
LICENSED CONT ACTOR'S DECLARATION
I hereby (firm u der penalty of perjury at'I am licensed d r provisions of Chapter 9 (commencing with
Se ion 00) f Division 3 of the Bu in s and Prof,ssio Is ode, and my License is in full force and effect.
Lic n a Li nse No.: 672285
at ontractor:
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 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 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 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.). -
( 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:
Lender's Address:
LQPER.AIIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/08/09
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN n
8800 N GAINEY CENTE j0 w
SCOTTSDALE, AZ 8525 UU
OCT l rN
Contractor:
SHEA HOMES, INC. CfiY �P �••M g3}i���R
60800 TRILOGY PARKWA F�'.1p_ ;:�'•'f�
LA QUINTA, CA 92253
(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
pe
rson iany manner so as to beco. a subject [o the workers' compensation laws of California,
that, if I should becom subject t workers' compensation provisions of Section
he labor C I hall fo ply with those provisions.
e:licant:
WARNSECURE WOR E S' COMPENSATIONCOVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL NALTIES 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 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 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'Ouinta, 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.
I certify tha I have Ena
s application and state that the above information is correct. I agree to comply with all
city and co my ordand state laws relating to building construction, and hereby authorize representatives
of/thi/gp y t , enthe above-mentioned prope for inspection p[ ses.
aO ted 'L!\ ure (Applicant or Agent):
J
Application Number
. . . . 09-00000947
Permit . .
. SPECIAL INSPECTION
Additional desc .
Permit Fee . . .
. 100.00 Plan Check Fee
.00
Issue Date . . .
. 9/14/09 Valuation . . .
. 100
Expiration Date
4/04/10
Qty Unit Charge
Per
Extension
BASE .FEE
100.00
------------------------
Special Notes and
----------------------------------------------------
Comments
SPECIAL INSPECTION
TO FINAL SFD UNDER
RIVERSIDE COUNTY PERMIT
#BRS023469.
CHANGE OF CONTRACTOR FEE ASSESSED TO
INSERT SHEA 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
LQPERMIT
P,,.O. BOX 1504
7$-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&t!t44Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/03/09
Application Number:
09-00000947
Owner:
Property Address:
61021 DESERT ROSE DR
SHEA LA QUINTA
APN:
764-270-999-134 -300231-
C/O JEFF MCQUEEN
Application description:
SPECIAL INSPECTION
8800 N GAINEY CENTER
b
Property Zoning:
Application valuation:
MEDIUM HIGH DENSITY RES
100
SCOTTSDALE, AZ 85258
Contractor:
Applicant:
Architect or Engineer:
SHEA HOMES LIMITED PART R
H
60800 TRILOGY PKWY
LA QUINTA, CA 92253
(760)777-6032
-------------------------------------------------------------------------------------------------
1`
Lic. No.: 855368
LICENSED CONTRACTOR'S DECLARATION
I her JE-,eontract/r:
penalty of rI ry that I am li ensed under provisions of Chapter 9 (commencing with
_52ct ision 3 of t e that
an I essionals Code, and my License is in full force and effect.
Li s13 LicenseNo.: 855368
D 'it Do
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 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 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 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.).
(_ 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:
Lender's Address:
LQPERMIT
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.
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 ertify that, in the performance of the work for which this permit issued, I shall not employ any
person in any manner so as to become subject to the workers' mpensation laws of California,
Wandhat, iVWRS'
me ubject to the work s' com nsation provisions of Section
a Labf hwith complys s.atcant: ClIq
WARNING: FAILURE TO SECURCOMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CLTIES 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 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 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.
Ice i ha I have read this application and state that the abo a information is correct. I agree to comply with all
ci o ty ordinances and state laws relating to ildi g onstr ction, a d hereby authorize representatives
to enter u n the above-mentioned pr p rty o p do poses.
at Signature (Applicant of Agent):
IV
Application Number . . . . . 09-00000947
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 #BRS023469.
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