06-0704 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 06-00000704
Property Address: 81795 EAGLE CLAW DR
APN: 764.-280-999-117 -30023.5-
Application description: WALL/FENCE
Property Zoning: MEDIUM HIGH DENSITY RES
Application valuation:400.0
c&t!t444"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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LICENSED CONTRACTOR'S. DECLARATION
I hereby affirm under penalty 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 is in full force and effect.
U Class: B UcenseNo.:: 672285
actor:
OWNER-BUILDER'DECLARATION.
!'.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 pursuanttcahe provisions of the Contractor's State
ns
Licee 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 di' by
any applicant for a permit subjects'the applicant to a civil penalty of not more,than five hundred dollars, ($500).,: do
f _ 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 oroffered1orsale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
andwho does.the work himself or herself through his or her'own employees, provided thatAhe
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 Ior
improve for the purpose. of sale.).
(_) 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 _ 1 I am exempt under Sec. , B.&P.C. for this•reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm:underpenalty 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:
r DilM, IN 11
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/16./06
Owner:
SHEA LA QUINTA.
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350
GnOTTSDALE, AZ 85258
HOMES , INC .
60 AVENUE 62
UINTA, CA 92253
)777-6005
c. 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 otconsentto-setf-insure for workers' compensation, as provided
for by Section 3700'.ofthe Labor Code, for the performance of the,work for which this permit is
{� issued.
1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
7- Code, for the performance of the work for which this permit Ls,issued. My workers' compensation
insurance carrier and policy number are:
Carrier AMERICAN HOME Policy Number 1247619
_ 1 certify that, in the performance.of the work for which this permit is issued;. I "shall not'employ any
person In manner so as to become subje to the workers' compensation laws of California,
and agree that, if. I should subjectt a workers' compensation provisions of Section
13700 of the Labor, Codi2flFall forth Cr I wKh those provisions.
L
ate: plicant:
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 ($100,000). IN ADDITION TO THE COST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST; AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety fora 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 pursuam;to any permit issued as a result ofthis application,
the owher, and the applicant, each agrees to, and shall defendi 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 dete;of issuance of such permit, or cessation of work for, 180 days will subject
permit to cancellation.
I certify Ihat.l have read this application and state that the above information incorrect. I agree to comply with.all
city and county ordinaVp.r,dto laws relating to building consvucrion,.a hereby authorize representatives
ofun'to(fanterove-mentioned property f `ionD bplicant or Agent):
Application Number . . . . . 06=00000704
Permit . . .. WALL/FENCE PERMIT
Additional desc . .
Permit Fee 63.00
Plan Check
Fee
00
Issue Date . . .
Valuation
. . .
. 4000
Expiration Date . . 8/15/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
2.0.0 9.0000 THOU BLDG 2,001-25,000
18.00
------------------------ -
Special Notes and Comments
160 L.F: 6' GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid
Credited
Due
Permit Fee Total 63.00
,00
.00
63.00
Plan Check Total .00
.00
.00
.00
Grand Total 63.00
.00
.00
63.00
LQPERmff