09-0944 (SPIN)Ab ti�
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 09-00000944
Property Address: 61055 DESERT ROSE DR
APN: 764-270-999-131 -300231-
Application description: SPECIAL INSPECTION
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 100
T-4ht 4 4 0"
Applicant: Architect or Engineer:
lA
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LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm u er penalty of perjury the I amZ
sed uer povisions of Chapter 9 (commencing with
Sec ion 000) of ivi ion 3 of the Bu in s nd ssi1,allocre, and my License is in full force and effect.
Lic la nse No.: 672285
rivactor:
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.l.
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: �•1
Lender's Address: I t
LQPERMIT
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CE'.
SCOTTSDALE, AZ 8
Contractor:
SHEA HOMES, INC.
60800 TRILOGY PAR
LA QUINTA, CA 922
(760)777-6005
Lic. No.: 672285
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/08/09
350 0 I
FAY C:TY PF . A (.iWI i 0 —
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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 subj t to the workers' compensation provisions of Section
�((\ /v/,,1 700 of the Labo e, 1 shat foi[hwi co ply with those provisions.
�-+ 1 plicant:
WARM G: FAILURE TO SECURE W ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMI L PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,0001. 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.
1 certifyt [ 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 building construction, and hereby authorize representatives
of is con to nter upon t eabove-mentioned propett �instionrposes.
,0 e: nature (Applicant or Agent): i
Application Number . . . . . 09-00000944
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
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Special Notes and
Comments
SPECIAL INSPECTION TO FINAL SFD UNDER
RIVERSIDE COUNTY
PERMIT #BRS023466.
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
4 P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 9/03/09
Application Number: 09-00000944 Owner:
Property Address: 61055 DESERT ROSE DR SHEA LA QUINTA
APN: 764-270-999-131 -300231- C/O JEFF MCQUEEN
Application description: SPECIAL INSPECTION 8800 N GAINEY CENTER 350
Property Zoning: MEDIUM HIGH DENSITY RES SCOTTSDALE, AZ 8.5258
Application valuation: 100 a
Contractor: D
Applicant: Architect or Engineer: SHEA HOMES LIMITED PI ERSHIP
60800 TRILOGY PKWY SEP 14 2009
LA QUINTA, CA 92253 _
(760) 777-6032 CITY OF LA QUINTA
�'A. Lic. No.: 855368 FINANCECEPT.
------------------------ 7 ---------------- ----------------------------------------------------------
LICENSED CONT ACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I er by affi under penalty of per j ry t I am licens d u der provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
S n 700 ) of Division 3 of the i s and Prof io s Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
e I s B i ns o.: 855368 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
to omractor: 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier NTL UNION INS Policy Number WC69 825
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the *RIERS'
work for which this er it is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any mae subject to the we k s' cpmpensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State nd agree that, iubject to t e work ensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 0 of the Labwnh,com' with t se provisions.
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).: at pplicant:
(_ 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 WARNING: FAILURE TO SECURPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors'State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). APPLICANT ACKNOWLEDGEMENT
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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: P
LQPERMIT
of La Quinta, its officers, agents and employees for any actor 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 enced
within 180 days from date of issuance of such permit, or cessation of work for 180 da will subject
permit to cancellation.
I certify hat I ave read this application and state that the above inf rmation is correct. I agree to ply with all
city a d unt o!rdinances and state laws relating to bW
hereby autho 'ze r sentatives
o nt ter u n the above-mentioned propate ignature (Applicant or Agent):
S`
Application Number . . . . . 09-00000944
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 #BRS023466.
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
LQPERMIT