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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