06-1206 (BLCK)4
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 3/24/06
Application Number: 06-00001206 Owner:
Property Address: 61285 FIRE BARREL DR SHEA LA QUINTA
APN: 764-280-999-132 -300235- C/O JEFF MCQUEEN
Application description: WALL/FENCE 8800 N GAINEY CENTER 350
Property Zoning: MEDIUM HIGH DENSITY RES SCOTTSDALE, AZ 85258 D
Application valuation: 2250 a
Contractor: p e
Applicant: Architect or Engineer: SHEA HOMES, INC. MAR 28 ZOO6
81260 AVENUE 62
LA QUINTA, CA 92253 CITyOFLgQu
(760) 777 -boos FI—MNCEDEPT q
LiC. No.: 672285
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7 00) of Di i i n 3 of the Bus' s and Profe sia als Code, and 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
Lic C icense No.: 672285 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
=— ] issued.
a ntractor: �I 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier AMERICAN HOME Policy Number 12 7619
following reason (Sec. 7031,5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which is permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the _ person in any manner so as to become subject to tW workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and a ee that, if I should 0@coSILJubje 0 o ation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 0 L or Code, o with comply ith those provision .
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).: ate. plicant: .
( 1 1, 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 WARNING: FAILURE TO SECURE W ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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:
LQPERMIT
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.
I . 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 ' work is not commenced
within 180 days from date of issuance of such permit, or cessation ork for 180 days will subject
permit to cancellation.
I certify t t I haver ad this application and state that th a formation i c . to comply with all
A
o modin nceandstate laws relating to building con tru ereby authorizer resentatives
-mentioned perty ins ection p poses.plicant or Age
Application Number . . . . . 06-00001206
Permit . .
. WALL/FENCE
PERMIT
Additional desc .
.
Permit Fee . . .
. 54.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 2250
Expiration Date
9/20/06
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
LOT 132. 90 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
LQPERDIIT