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09-0951 (SPIN)k- P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: Applicant: 09-00000951 61042 DESERT ROSE DR 764-270-999-127 -300231- SPECIAL INSPECTION MEDIUM HIGH DENSITY RES 100 c&ty/ 4 4 Q" Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: SHEA LA QUINTA C/O JEFF MCQUEEN 8800 N GAINEY CENTER 350 SCOTTSDALE, AZ 85258 ilUff Contractor: SHEA HOMES, INC. 60800 TRILOGY PA VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/08/09 L/ U U OCT 19 2008 ` . LA QUINTA, CA 92253;J (760) 777-6005 ClTY(1f%t�( 1Jiid'i'i4 Lic. No.: 672285/ --------------------------------------------------------------------------------------------- •�. sc{-' LICENSED CONTRACTOR'S DECLARATION I hereby ffirm u er penalty of perjy t at I am licens nder provisions of Chapter 9 (commencing with Se tion 01 of ivision 3 of the Bb 'ri s and Profes o als Code, and my License is in full force and effect. Lic n e O is a No.: 672285 C tractor: 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 _ 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. 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 the workers' compensation laws of California, d agree that, if I should become subject t the workers' compensation provisions of Section 7��,�0////0����of the Labor C I shall forth!' with those provisions. e: ant: WARNIN : FAILURE TO SECURE WOR S' COMPENSATION COVERAGE IS 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. 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 t at I have read this application and state that the above information is correct. I agree to comply with all city and c unty o dinances and state laws relating to bu" g construction, and hereby authorize representatives of his co ty to nter upo The above-mentioned prop y, for ' spection purposes. D nature (Applicant or Agent): Application Number Permit . . . Additional desc . . Permit Fee . . . . Issue Date . . . . Expiration Date . . . . . 09-00000951 SPECIAL INSPECTION 100.00 9/14/09 4/04/10 Plan Check Fee . _ .00 Valuation 100 Qty Unit. Charge Per Extension BASE FEE 100.00 ---------------------------------------------------------------------------- Special Notes and Comments SPECIAL INSPECTION TO FINAL SFD UNDER RIVERSIDE COUNTY PERMIT #BRS023473.' 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 78,495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 09-00000951 Property Address: 61042 DESERT ROSE DR APN: 764=270-999-127 -300231- Application description: SPECIAL INSPECTION Property Zoning: MEDIUM HIGH DENSITY RES Application valuation: 100 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- I:SED CO TR TOR'S DECLARATION I h irm and penalty of perjury am license un er provisions of Chapter 9 (commencing with S do 0 of 3 of the Bus ess nd Profess' na Code, and my License is in full force and effect. Li a cense NO.: 855368 Date: tractor: _ I� 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, 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.). (_) 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 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 Owner: SHEA LA QUINTA C/O JEFF MCQUEEN 8800 N GAINEY SCOTTSDALE, AZ Contractor: SHEA HOMES LIM 60800 TRILOGY LA QUINTA, CA (760)777-6032 Lic. No.: 855368 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/03/09 ----------------------------------------------- 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. 1 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 _ 1 certify that, in the performance f the work for which this perm' is issued, I shall not employ any person in any manner so as become subject to the worker pensation laws of California, and agree that, if I sho d b m subject to a or ers' pensation provisions of Section 700 of the Labor C de, s 11 hv�h co ly ' h os provisions. t A scant: WARNING: FAILU TO SECURE W R RS' COMPENSATION COVERAGE IS 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. 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 co mence, within 180 days from date of issuance of such permit, or cessation of work for 180 d s will subject 6tl..haa cancellation. I certify thd this application and state that the above inf matt is correct. I agree to omply with all city nnces and state laws relating to building constrdoand hereby authorize atives of hi 4/iature a above-mentioned property r inspe urpoees:te: (Applicant or Agent,: e LQPERMIT Application Number . . . . . 09-00000951 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 #BRS023473. 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 0