06-1405 (BLCK)T-v4t
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: 4/06/06
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
06-00001405
61380 FIRE BARREL DR
764-280=999-146 -3002
WALL/FENCE
MEDIUM HIGH DENSITY R
4375
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N GAINEY CENTER 350
SCOTTSDALE, AZ 85258
�fJ�e Contractor:
Applicant: Architect o Engine r: �T 7 n SHEA HOMES, INC.
19 i�/[•',` ��oUs _
2 6
LA QUINTA, CA 92253
(760) 777-6005
Lic. No.: 672285
-
-=----------------------------------------=-----------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of per'o t at I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
cti n 7 0) o ivi 'on 3 of the us e s and Prof ssi pals 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
L en I s, License No.: 672285 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
ate: + ontractor: 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 N mber 1247619
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to 1 certify that, in the perf ance of the wo for which this 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
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.).
1 _ 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.).
( 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
person in any manner s a o become bject to the workers' compensation laws of California,
agree that, if I' be om u ' ct to the workers' compensation provisions of Section
IN f the b Cod sh Il�rth ith com ly with those provisions.
4 r
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 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 nutri void if work is not commenced
within 180 days from date of issu0ofpermit, or sation of work for 1BO days will subject
perm: to cancellation.
I ce if that ha ad this application and staovI agree to comply with all
city n co y antes and state laws relatcuthorize representatives
oft is ✓ toen on eabove-mentionrite: nature (Applicant
�. Application Number . . . 06-00001405
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 72.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 4375
Expiration Date 10/03/06
Qty Unit Charge Per
Extension•
BASE FEE
45.00
3.00 9.0000 THOU BLDG 2,001-25,000
=
.27.00
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Special Notes and Comments
175 L.F. 6- GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid
Credited
Due
Permit Fee Total 72.00
.00
.00
72 OC=
Plan Check Total .00
.00
.00
.00
Grand Total . 72.00
.00
.00
72.00
LQPERMIT