06-2887 (BLCK)P.O. BOX 1504
78495 .CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
Tay 4 4 Qumm
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/09/06
Application Number: 06-00002887 Owner:
Property Address: 81810 EAGLE CLAW DR SHEA LA QUINTA
APN: 764-280-999-37 -300235- C/O JEFF MCQUEEN
Application description: WALL/FENCE 8800 N GAINEY CENTER 350
Property Zoning: MEDIUM HIGH DENSITY RES SCOTTSDALE, AZ 85258
Application valuation: 1750
Contractor:
Applicant: Architect or Engineer: SHEA HOMES, INC.
81260 AVENUE 62 NW LA'QUINTA, CA 92253
(760)777-6005
Lic. .No.: 672285 -------------------------------------------------------------- --
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby ffirm u der panalty of perjury het I.am licensed under provisions of.Chapter 9 (commencing with I hereby, affirm under penalty of perjury one of the following declarations;
Seot on } of ivision 3 of th as and Prof i als Code, end 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
LI' se canoe No.: 6 722 B5 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
1.De[e: 1 "TWactor. Lhave and will maintain workers' compensationinsurance, as required by Section 37001of 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 under penalty of perjury that 1, am exempt from the Contractor's State License Law for the Carrier AMERICAN HOME Policy Number 1247619
following reason,(Sec. 7031:5„Business and Professions Code: Any oily or county thet requires a permit to _ 1 certify that, in the performance of ttwwork for which this permit is issued, I shall.not employ any
construct, alter, improve, demolish, or repair structure, prior to its issuance; also requires the applicant for the rso- fn any man so as o.be me subject to the orkers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provision of the Contractor's State nd agree'thet, if,
1 s om subjectto the wo is compensavon,provisions of Section
License law (Chapter9 (commencing with Section 7000) of Division 3 of the Business and Profession Code) or I j00 of the La e; all fthwith compt�ithose provisions.
that he or sheds 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, ormy 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 Profession Code: The
Contractors' State Ucense Law does not apply to an owner of property who builds or improves thereon,
and who does the,work himself or herself Ithrough his or her own employees, provided that the
improvements are not intended or offered forsale. 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 saleJ..
1—) I, as owner of the.property, am exclusively contracting with licensed contractors 4o construct the project;ISec.
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 Lioense.Law.).
1 _) I am exempt under Sec. , B.dP.C: for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that,there'is aconstruction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. CJ.
Lender's Name:
Lender's Address:
LQPERMIT
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'3706�OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is herebymade 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 pursuam.to any'permit issued ass result of this application,
the owner, and the.applicant, each agrees to, and shall defend, indemnifyand hold harmless�the City
of La Quints, its officers; agents and employees forany act or omission related to the work being
performed under w 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 dateof issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certNy thatl h e reed this application and st above or wn'�s c act. Isgraet. comply with all
cit unty m and state laws rola ng to ng co ructi nd byauthorae representatives
of nri.f en16r Joon the.above-menti. or rt for ins io
or
Q
Application Number . . . . . 06-00002887
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . 41.00 Plan Check 'Fee 00
Issue Date . . . . Valuation . . . . 1750
Expiration Date 1/30/07
Qty Unit Charge Per Extension
BASE FEE 15.00
13.00 2.0000 FIND BLDG 501-2,000 26.00
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Special Notes and Comments
LOT 37 - 145 L.F. 6' GARDEN WALL, ORCO
SYSTEM
Fee summary Charged
------------------ ------- --
Permit.F.ee Total 41.00
Plan Check Total .00
Grand Total 41.00
1C�7•�;�ulYl
Paid Credited Due
.00 .00 41.00
.00 .00 .0.0
.00 .00 41.00