09-0942 (SPIN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/08/09
Application Number: 09-00000942 Owner:
Property Address: , 61079 DESERT ROSE DR SHEA LA QUINTA
APN: 764-270-999-129 -300231- C/O JEFF MCQUEEN
Application description: SPECIAL. INSPECTION 8800 N GAINEY CENTER 350
Property Zoning: MEDIUM HIGH DENSITY RES SCOTTSDALE, AZ 85258 1
Application valuation: 100•
Contractor:
Applicant: Architect or Engineer: SHEA HOMES, INC. t b
60800 TRILOGY PARKWAY
�) LA QUINTA, CA 92253
(760) 777-6005
Lic. No.: 672285
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affi under enalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Secti 700 1 f iv i n 3 of the Busi ss nd Professio
ails de, and my License is in full force and effect.
Licens s Lic se No.: 672285
e: ractor:
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 1$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 _ 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.).
(_ ) 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 to become subject t the workers' compensation laws of California,
and a ee that, if 1 sho om subject to the orkers' compensation provisions of Section
v 00 f the Labor Co ha rthwith se provisions.
Q ica
WARNING: FAILURE TO SECURE WORKEMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 15100,0001. 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 Ovinta, 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 th t I have read this application and state that the above i�ormation is correct. I agree to comply with all
city nd o my ordina ces and state laws relating to buil nsfru tion, and hereby authorize representatives
oft s o y to upon the above-mentioned pro rt or s ec o purpo gs.
at ig (Applicant or Agent):
Application Number . . . . . 09-00000942
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
#BRS023464.
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: 09-00000942
Property Address: 61079 DESERT ROSE DR
APN: 764-270-999-129 -300231-
Application description: SPECIAL INSPECTION
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation: 100
T-4ht 4 4 Q"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I her btaffiunder penalty of peri t I am lice s dunderprovisions of Chapter 9 (commencing with
ct ision 3 of the sin sand Profs ovals Code, and my License is in full force and effect.
a sB LicenseNo.: 855368
tractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License taw 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 _ 1 1, 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 I am exempt under Sec. , BAP.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: Y
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/03/09
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN n
8800 N GAINEY CENTER lU{
SCOTTSDALE, AZ 8525 D
SEp 1 � 2009
Contractor:
SHEA HOMES LIMITED P NRSHI
of
60800 TRILOGY PKWY WFC+""'" -•
LA QUINTA, CA 92253
(760)777-6032
Lic. No.: 855368
-----------------------------------------------
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 L UNION INS Policy Number WC6987825
I certify that, in the performance of the work for which this per 't is issued, I shall not employ any
person in any manner so as to become subject tot a worke compensation laws of California,
and agree that, if.l should be m subject to he rkers' a ation provisions of Section
0 of the LabIWORS'
h II rthwith co ply 'th pr Bions.
ate:
pp",
WARN( G: FAILURE TO SECURCOMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJE AN EMPLOYER TO CNALTIES 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 subjecC'm 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
per it to cancellation.
I certif t at I h e read this application and state that the ab ve information is c act.- I agree to comply with all
city nty rdinances and state laws relating t uil�conon and h eby authorize representatives
of t' c mer upo the above-mentioned o e n s
Date: gnature (Applicant or Agent):
Application Number . . . . . 09-00000942
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 #BRS023464.
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
LQPERM IT