09-0945 (SPIN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 09-00000945
Property Address: 61047 DESERT ROSE DR
APN: 764-270-999-132 -300231-
Application description: SPECIAL INSPECTION
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 100
Tit�/ 4 4 0"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
-------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby ffirm u der penalty of perjury t at I am licensed oder provisions of Chapter 9 (commencing with
S' tion 000) o Division 3 of the )ser and Profession Is- ode, and my License is in full force and effect.
Li e I s Lic nse No.: 672285
e: ntractor.
Ct:i,edd."r
OWNER -BUILDER DECLARATION
I hereby: affirrn;under penalty of perjury that I am exempt from the Contractor's State License Law for the
followindreason (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).:
(_) 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.).
(_) 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.).
( ) 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: �1L�
Lender's Address:
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 85- LA
D 1
Contractor: J ZUs� €�
SHEA HOMES INC. �' `
60800 TRILOGY PARKAY_
LA QUINTA, CA 9225 0c +`�'"•�(���A
(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.
Y� 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,
"nd agree that, if I should become su i t t the workers' compensation provisions of Section
700 of the Labor C I shall fo with mply with those provisions.
D e: pp
licant:
WARNING: FAILURE TO SECURE WORK'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL ALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001. 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 that I have read this application and state that the above information is correct. I agree to comply with all
city and c unty ordinances and state laws relating to building construction, and hereby authorize representatives
of tXrhisc1\o ty toe • er upon the above-mentioned property r inspection purposes.
yatp: L.J
re (Applicant or Agentl:
Application Number . . . . . 09-00000945
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 #BRS023467.
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:
09-00000945
Property Address:
61047 DESERT ROSE DR
APN:
764-270-999-132 -300231-
Application description:
SPECIAL INSPECTION
Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
100
T-it!t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENT&
SCOTTSDALE, AZ 8525
Contractor:
Applicant: Architect or Engineer: SHEA HOMES LIMITED
60800 TRILOGY PKWY
LA QUINTA, CA 92253
�/� (760) 777-6032
Lic. No.: 855368
LICENS C NTRACTOR'S DECLARATION
I hereWity of perjur that I am li n under provisions of Chapter 9 (commencing with
Se i3 of t ness and Pr fe ionals Code, and my License is in full force and effect.
licenseNo.: 855368
Dattrac r:
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 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.).
(_) 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
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
f� issued.
1, 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 issue , 1 shall not employ any
person in any manner so as to become bject to the workers' mpen ation laws of California,
and agree that, if I should become subj [ to the workers omp n ti ovis' ns of Section
700 of the Labor Code, I shall forth h c ply with t e pr vi
Date: pplicant:
WARNING: FAILURE TO SECURE WORKERS' 0 PENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PEN LT S AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE OST 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.
lDatm
that I ave read this application and state that the above infoLnpu'rFoses..
is correct. I agre to comply with all
o ordinances and state laws relating to building co trnd hereb uth r resentatives
o enter upon the above-mentioned pro e y for in ec
r Signature (Applicant or Agent):
Application Number
Permit. . .
Additional desc .
Permit Fee
Issue Date . . . .
Expiration Date . .
09-00000945
SPECIAL INSPECTION
100.00 Plan Check Fee .
Valuation . . . .
3/02/10
.00
100
Qty Unit Charge Per Extension
BASE FEE 100.00
----------------------------------------------------------------------------
Special Notes and Comments
SPECIAL INSPECTION TO FINAL SFD UNDER
RIVERSIDE COUNTY PERMIT #BRS023467.
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
LQPERD1IT