06-1203 (BLCK)R
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
06-00001203
61255 FIRE BARREL DR
764-280-999-129 -300235-
WALL/FENCE
MEDIUM HIGH DENSITY RES
2125
T-it!t 4 4 Q"
Architect or Engineer:
I Ja
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under enalty of perjury that I a licensed and revisions of Chapter 9 (commencing with
Section 7 001 of Divi on 3 of the Busin s d rofes ' nal ode, and my License is in full force and effect.
Lice ' C ss: L' tRSE*N 672285
1 14-A
tor:
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 ($500).:
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.l'.
(_ 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 t is permit is issued (Sec. 3097, Civ. C.).
Lender's Na
Lender's Addres
LQPERMIT
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350
SCOTTSDALE, AZ 85258
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/24/06
Contractor:
SHEA HOMES, INC. D B
81260 AVENUE 62
LA QUINTA, CA 92253
(760)777-6005 MAR 282006 8 c
Lic. No.: 672285 ZOO6
QUINTq
------------------
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.
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 AMERICAN HOME Policy Number 1247619
I certify that, in the performance of the rk for which this permit is issued, I shall not employ any
rson in any manner so as to bec a ubject to the workers' compensation laws of California,
a d aee that, if Is eco m sub' ct to the workers' compensation provisions of Section
e Labor Co e, I hall I with those provisions.
at Ap
WARNING: FAILU E 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 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 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 cess ion of work for 180 days will subject
permit to cancellation.
I ceinfN that I hake read this application and state that Mbovematio is correct. I agree to comply with all
"ci
es and state laws relating to btion, authorize representatives
t bove-mentioned prop' rposes.
nature (Applicant or Agent
Application Number . . . . . 06-00001203
Permit
WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . .
. 54.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 2125
Expiration Date
9/20/06
Qty Unit Charge
Per
Extension'
BASE
FEE
45.00
1.0.0 9.0000
THOU BLDG
2,001-25,000
9.00
--------7-------------------------=-----------------------------------------
Special Notes and
Comments
LOT 129. 85 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
LQPERMIT