09-0946 (SPIN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 09-00000946
Property Address: 61035 DESERT ROSE DR
APN: 764-270-999-133 -300231-
Application description: SPECIAL INSPECTION
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 100
Applicant:
Tiht 4 4 Q"
Architect or Engineer:
BUILDING& SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350 OCT 1 t0J9
SCOTTSDALE, AZ 85258
GIT`! =� Ac:ii1EJ"iA
Contractor: �°�`" • •
SHEA HOMES, INC.
60800 TRILOGY PARKWAY
/09
LA QUINTA, CA 92253
(760)777-600S
Lic. Noo..:: 67 672285
-------------------------------------------------------------------------------------------------
1 LIC NSED CONTRA1CT0 'S DECLARATION
under benalty Of perjure licensed unr previsions of Chapter 9 (commencing with
of Divilrion'n�t1,,'I the B i ess a Professionals Cod and my License is in full force and effect.
c . n en`se No.: 672285
ate:ntractor:
UI\-UkFk-
V
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 _ 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 sate. 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 1 1 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.
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: ,
Cairier NTL UNION INS Policy Number WC698782S
Icertify that, in the performance of the work for which this permit is issued, I shall not employ any
i rson in any manner so as to become su ' c to he workers' compensation laws of California,
agree that, if Iaome subi a workers' compensation provisions of Section
of the Laborall fo/ ith c mply with those provisions.
ate: I plicant:
WARNING: FA LURE TO SECURE' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL
SUBJECT AN EMPLOYER TO CRIMIN4 VNALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION •`f 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
per it to cancellation.
I certify that I h e read this application and state that t above information is correct. I agree to comply with all
ci y n nt r i nces and state laws relating to it ing construction�S. and hereby authorize representatives
o t n r upon the above-mentioned pro
ate: Si ure (Applicant or Agent):
t
LQPERAIIT
Application Number
09-00000946
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 #BRS023468.
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 '
10450 100.00 .00
4.50
l
t
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 09-00000946
Property Address: 61035 DESERT ROSE DR
APN: 764-270-999-133 -300231-
Application description: SPECIAL INSPECTION
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 100
Applicant:
Tiht 4 4 Q"
Architect or Engineer:
p,l Pit
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Bus' ess and Professionals Code, and my License is in full force and effect.
Li a ss A, B � License No.: 855368
ate: 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 1$5001.:
(_ 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 ISec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPER1%11T
Owner:
SHEA LA QUINTA
C/O JEFF
8800 N GA
SCOTTSDAL
Contractor:
SEP 141009
SHEA HOMPOG
TNERS
60800 TR�F�Q(J�NrA
LA QUINTeoep _(760)777
Lic. No.: 855368
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/04/09
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 WC6987825
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
workers' compensation laws of California,
and agree that, if I should beco a subject to the kers' compensation provisions of Section
of the Labor Code, I shal f hwith c ply th hose provisions.
ate: plicant:
WARNIN��,7
L RE TO SECURE WO E 'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINA 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 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.
I certify hat I have read this application and state that the above information is corr I agree to comply with all
city a ount ordinances and state laws relating to building c ns ion, and here authorize representatives
of tt nt nter upon the above-mentioned pro y for sp ctiQn p oses.
Date: Signature Applicant or Agent):
Application Number . . . . . 09-00000946
Permit . .
. SPECIAL INSPECTION
Additional desc .
.
Permit Fee . . .
. 100.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 100
Expiration Date
3/03/10
Qty Unit Charge
Per
Extension
BASE FEE
100.00
----------- ----------------------------------------------------------------
Special Notes and
Comments
SPECIAL INSPECTION
TO FINAL SFD UNDER
RIVERSIDE COUNTY PERMIT
#BRS023468.
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
LQPERAIIT