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