08-0228 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
08-00000228
Property Address:
81497 GOLDEN POPPY WY
APN:
764-280-999-126 -300236-
Application description: ,
WALL/FENCE
Property Zoning:
MEDIUM HIGH DENSITY RES
Application valuation:
3750
Applicant: Architect or Engineer:
8
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/30/08
Owner:
SHEA LA QUINTA
C/O JEFF MCQUEEN
8800 N CENTER 350
SCO
SCOTTSDALEALE, A AZ 85258
F84 L,ontractor:
A HOMES, INC.
06, 800 TRILOGY PARKWAY
lQo� A QUINTA, CA 92253
VA� pQV/�Ir
(760)777-6005
6
Lic . No.: 6702285
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LICENSED CONTRACTOR'S DECLARATION
I hereb affir under penalty of perjury at 1 am 1'cens d under provisions of Chapter 9 (commencing with
S '0 70001 of Division 3 of the B si ss and Prof ss ovals Code, and my License is in full force and effect.
Li en a la s: ) License No.: 672285
ate: �tractor:
Ubou—vtq L---
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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).:
(_ 1 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 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 forthe purpose of sale.).
(_ 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.I.
Lender's Name:
Lender's Address:
LQPERMIT
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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
1 issued.
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
insurance carrier and policy number are:
Carrier AMERICAN HOME Policy Number CA 1593364
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
rson in any manner so as to become subj t to the workers' compensation laws of California,
d agree that, if I should ecome subject o the workers' compensation provisions of Section
P�1 0 of the Labor Cod I s I orthwith ply with those provisions.
Date, licant:
WARNING: FAI URE TO SECURE WORK RS' OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL EN TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001 IN ADDITION TO 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 cessation of work for 180 days will subject
permit to cancellation.
a ify th t I have read this application and state that the above information is correct. I agree to comply with all
c my ordinances and state laws relating to building construction, and ereby authorize representatives
of ut to enter upon the above-mentioned prope f i pection purpo s.
D Si ture (Applicant or Agent):
Application Number . . . . . 08-00000228
Permit . _ . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 63.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 3750
Expiration Date.. 7/28/08
Qty Unit Charge Per
Extension
BASE FEE
45.00
2.00 9.0000 THOU BLDG 2,001-25,000
18.00
Special Notes and Comments
150 L.F. 6' GARDEN WALL, ORCO SYSTEM
i
-
Fee summary Charged Paid' Credited
---------------------------------------------------------
Due
Permit Fee Total 63.00 .00
.00
63.00
Plan Check Total .00_ .00.
.00
.00
Grand Total 63.00 .00
.00
63.00
LQPE"11T