05-5481 (BLCK)P. 0;1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
L05-000054.81-
818355GGOLDEN STAR WY
764-280-999-83 -300235-
WALL/FENCE
MEDIUM HIGH DENSITY RES
1875
BUILDING & SAFETY DEPARTMENT
DING PERMIT
7$!Cloa
Owner:
Q$HEA LA QUINTA
pC/O JEFF MCQUEEN
- 8800 N GAINEY CENTER 350
�v
SCOTTSDALE, AZ 85258
OA
e JQ u- Contractor:
Architect or Engineer: v SHEA HOMES, INC..
81260 AVENUE 62
LA QUINTA, CA 92253
(760)777-6005
Lic. No.: 672285
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7 00) of ivision 3 of the Busine and Profes n Is Code, and my License is in full force and effect.
Lice e l s B icense No.: 672285
v
te: ontractor:
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 ISec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair anystructure, 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 _) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is novintended 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.). -
(_) 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 contractorls) 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/16/05 .
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.
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 N bil er 1247619
_ I certify that, in the perfor a of the wo or which this permit is issued, I shall not employ any
( 10`0
on in any mann s as o become bI. to the workers' compensation laws of California,
I agree that, if sho b com u sect to the workers' compensation provisions of Section
I of the Lab Cod , all fortw'* Ii I{� W yu'{• yyu h those 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 ($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 ermit, or cessation of work for 180 days will subject
permit to cancellation.
I certify tdhave this application and state that the formation is rrect. I agree to comply with all
city cces and state laws relating to ' in cc ruc d ereby authorize representatives
of t c pon the above-mentioned prope in pection pur s
atenature (Applicant or Age 1:
Application Number . . . 05-00005481
Permit
WALL/FENCE PERMIT
Additional desc .
Permit Fee
43.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
1875
Expiration Date
6/14/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
14.00 2.0000 HND BLDG 501-2,000
28.00
--------7------------------------------------------7------------------------
Special Notes and
Comments
75 L.F. 6.' GARDEN
WALL, ORCO SYSTEM
Fee summary
Charged Paid
Credited
Due
Permit Fee Total
43.00
..00
.00
43.00
Plan Check Total
.00
.00
.00
.00
Grand Total
43.00
.00
.00
43.00
LQPERMIT