06-0705 (BLCK)P.O. BOX, 1504
784,95 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T -,&t 4 4 0"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011.
INSPECTIONS (760) 777-7153
Date: 2/16/06
Application Number: 06-00000705 Owner:
Property Address: 81825EAGLE CLAW DR SHEA LA QUINTA
APN: 764-280-999-118 -300235- C/O JEFF MCQUEEN
Application description: WALL/FENCE 8800 N GAINEY CENTER 350
Property Zoning: MEDIUM HIGH DENSITY RES SC2g.2JSDALE, AZ 85258
Application valuation: 2750 1---*— 0�
Applicant: Architect or Engineer: IJIEA S, INC.
O(G, , % 60 A CA 692253
EG� 77 - 005
6722$5
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1, am licensed under provisions of Chapter 9 (commencing with
Sectio 7000) of Division 3 of the Business and Professionals Code, and my License is in,full force and effect..
Lice- Class: Lice 'No.: 672285
/ OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's. State License Lew for the
following reason (Sec. 7031.5, Business and Professions Code: Anycity or, county that.requires a permit to
construct; alter, improve; demolish, or repair any structure, prior toAs issuance; also requires the applicant for the
permit to file a..signed statement that he or she is licensed pursuantto the provisions of the Contractor's State
License Law (Chapter9 (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 Section 7031.5 by
any applicant for -a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_) 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 herown employees; provided that the
improvements are not intended or offered for sale. 'If, however, the building or improvemenvis 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.).
(_) 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.).
1 _ 1 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:
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WORKER'S COMPENSATION' DECLARATION
I hereby affirm under penalty of perjury one -of the,following declarations:
_ 1 have and will: maintain's certificate of consent to self -insure for workers' compensation, as,provided
for by Section 3706 of the Labor Code, forrthe performance of the work.for which this permit is
issued.
1 have and will maintain workers' compensation insurance, as required by Section 3,700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insuranoe:carrier and policy numberr are:
Carrier AMERICAN HOME Policy'Number 1247619
_ I.certify that, in the performenae of the work,tpr
which this permit is issued, I shall not employ any
person in any manners as to.become su ct to the workers' compensation laws of California;
and agree tha[,.rf I shout - e sutije - •the workers' compensation provisions.of Section
�— _3i00 of the I1,fort comply withthose provisions..
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 (8100,000). IRADDITION TO THE COS OF'COMPENSATION,.DAMAGES AS PROVIDED FOR IN
SECTION 3768 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGMENT
IMPORTANT Application' is hereby made to the Director of Building aril Safety for a permit subject to the
conditions and restrictions�set forth on this application.
t. 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 axesult of this application,
the owner, and the.. applicant, each, agrees to, and shall defend, indemnify and hold harmlessAhe City
of Le Quint, 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 isnot commenced
within 180 days. from date 'ofissuance of such permit, or cessat" n of work for 1,80 days willsubjeet
permit to cancellation.
I certify that I have read this. application and state that the above informatio ' correct. I agree to comply with all
city and.county ordinances and state laws relatito mg construction d hereby authorize representatives
of. this Wnty rp enter upon th%atfove-mentigy for ins rposes.
Application Number
Permit . . .
Additional desc . .
Permit Fee . . . .
Issue Date . . .
Expiration Date . .
. . . . 06-00000705
WALL/FENCE PERMIT
54.00 Plan Check Fee . . .00
Valuation . . . . 2150
8/15/06
Qty Unit Charge Per Extension
BASE FEE 45.00
1.00 9.0000 THOU BLDG 2,001-25,000 9.00
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Special Notes and Comments
110 L.F. 6' GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid Credited Due
Permit Fee Total 54.00 .00 .00 54.00
Plan Check Total .00 .00 .00 .00
Grand Total 54.00 .00 .00 54.00
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