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09-0952 (SPIN)G _ ,1' PO; BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 09-00000952 Property Address: 61064 DESERT ROSE DR APN: 764-270-999-128 -300231- Application description: SPECIAL INSPECTION Property Zoning: MEDIUM HIGH DENSITY RES Application valuation: 100 c&,ht 4 4 4" Applicant: Architect or Engineer: � U a1R BUILDING & SAFETY DEPARTMENT BUILDING PERMIT --------------------------------------------------- CENSED CONTRACTOR'S DECLARATION I he*airmWpenaltyof perj th I am licensedLnderprovisions of Chapter 9 (commencing with Secf the usin s and Profes iond my License is in full force and effect. Lice o.: 672285 ctor: 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 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: n Lender's Address: fr 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 85258 Contractor: SHEA HOMES, INC. 60800 TRILOGY PARKWAY o LA QUINTA, CA 92253t Ik,�1R (760)777-6005M ,�. 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. .� 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 performanc of the work for which this permit is issued, I shall not employ any person in any manner so as t , become subject to the workers' compensation laws of California, and agree that, if I should be ome subject to the workers' compensation provisions of Section k 37 0 of the Labor C e, I s II fo i h ply with those provisions. ate u icant: WARNING: FAILURE TO SECURE WO K RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINA ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$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 cunty or 'nances and state laws relating to building construction, and hereby authorize representatives of t is hp e ter upon the above-mentioned rty f�inspen purposes. ature (Applicant or Agent): r/ 7 LQPERMIT Application Number . . . . . 09-00000952 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 #BRS023475. 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 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: 09-00000952 61064 DESERT ROSE DR 764-270-999-128 -300231- SPECIAL INSPECTION MEDIUM HIGH DENSITY RES 100 c&ty/ 4 4 Q" Architect or Engineer: PIK BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: SHEA LA QUINTA C/O JEFF MCQUEEN 8800 N GAINEY CENTER SCOTTSDALE, AZ 85258 Contractor: SHEA HOMES LIMITED PAR 60800 TRILOGY PKWY LA QUINTA, CA 92253 (760)777-6032 Lic. No.: 855368 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/03/09 ---- of officers -------------------------------------------------------------------------------------------- IJCENSED CONT CTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I by affirm under penalty of peri t I am licensed u er provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: ecti 00 f 'sion 3 of the sine and Profe siona 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 ice ass icense No.: 855368 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ate 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�n�ontractor: derpety of perjury that I am exempt from the Contractor's State License Law for the Carrier NTL UNION INS Policy Number WC6987 25 following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to Icertify that, in the performance of the work for which this per itis 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 manner so as to b corn subject to the worke compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State o a su ect to the workers' c n ation provisions of Section and agree that, iIWOR License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or / 700 of the Labal rt ith comply th t pr sions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 byany *AN applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: licant: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and �PLOYER the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The FAISECUR'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT ANE 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 (_) I, 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 _ 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 La Q' t -t d I f I 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: U �, LQPERMIT o a uin a, i s o kers, agents an emp ogees or any act or omission re ate d 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 �ld: will subject p mit to cancellation. I ttif at I ave readhis application and state that a abov inf mation is correct..) agrplywith all city n u ordinances and state laws relating to ilding c str tion, and hereb auth epresentatives of s toe ter u n the above-mentioned p rty ori tion purposes. . Da Signature (Applicant or Agent): Application Number . . . . . 09-00000952 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 #BRS023475. 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