06-0703 (BLCK)'%-t
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant -
06 -00000703
81785 EAGLE CLAW DR
764-280-999-116 -3.00235-
WALL/FENCE -
MEDIUM HIGH-DENSITY RES
4380
Architect or Engineer:
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LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
1 hereby affirm under penaity.of perjury that I am licensed under provisions. of Chapter,9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License Win full "forceand effect.
Linen Classf• _ B License No.: 672285
ete:�22 (�� ontrector: �"
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury'that 1 am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and,Professions Code: Any cityor county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to itsissuance, 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;o£the Business and Professions Code) or
that he or she is exempt therefrom and the basis1or 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 tharffive 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 Lew does,not apply to an owner of property who builds orimproves +++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 taw 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 Lam exempt.under,Sec. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby'effirm under penalty of perjury that there is a construction lending agency for the performanceof the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS(760) 777-7153
Date: 2/16/06
Owner:
SHEA LA QUINTA
F MCQUEEN
$_80.0 GAINEY CENTER 350
A E, AZ 85258
FESM tra or:
OM S, INC.
LA E 62
NTA, CA 92253
(760)777-6005
LiC. No..: 672285
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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 workfor which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier AMERICAN HOME Policy Number 1247619
_ I certify that, in the performance of the work for whidi:thia'permit is issued, l shall not employ.any
person in any manner so as to become subject to theworkers ' compensation laws of California,
and agree that, •d I should me subje o the workers' compensation provisions of Section
3 00 of the,Labor C" all forthw' ply with those provisions.
te: 2A� ican
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 10100;0001..IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3,706 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 persomat whose request -and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, andthe applicant; each.agrees"to, and shall defend, indemnify and hold harmless the City
of. La Quints, its officers, agents and employees for any act or omission related to thwwork 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 th •above informati is correct. I agree to comply with all
city and county ordinances an slate laws relating to buil onstruction nd hereby authorize representatives
of t�toterthe above=mentioned prope for pection rposes.
re (Applicant or Agent)
Application Number . . . . . 06-00000703
PermitWALL/FENCE PERMIT
al
Additiondesc .
Permit Fee . . . . 72.00
Plan Check
Fee
.00
Issue Date . . .
Valuation
. . .
. 4380
Expiration Date 8/15/06
Qty Unit Charge Per
Extension
BASE
FEE
45.00
3.0.0 9.0000 THOU BLDG
2,001-25;000
27.00
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Special Notes and Comments
140 L.F. 6' GARDEN WALL, 55 Z.F.
3'
RETAINING WALL, BOTH ORCO SYSTEM
Fee summary Charged
----------
Paid
Credited
---------- --..
Due
-------
------------------ -----------
Permit Fee Total 72.00
.00
.00
72..00
Plan Check Total .00
.00
.00
.00
Grand Total 72.00
.00
.00
72.00
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