05-4202 (BLCK)P.O: BOX 1504 ,` VOICE (760) 777-7012
78-495. CALLE TAMPICO -4( FAX (760) 777-7011
LA QUINTA,'CALIFORNIA-92253 BUILDING &SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 9/20/05
Application Number: ,405-00004202.• �+ Owner:
Property Address: 81201• VICTORIA LN ..SHEA LA QUINTA
APN: 764-270-999-127 -300234- C/O JEFF MCQUEEN
Application description: WALL/FENCE 88.00 N. GAINEY' CENTER 350
Property Zoning: MEDIUM `HIGH DENSITY RES D SCOTTSDALE, AZ 85258'
Application valuation: - 2400 G
OctContractor:
Applicant: Architect or Engi eer: Q SHEA HOMES, -INC.
5 81260 AVENUE 62
C10�^� 00" LA QUINTA, CA 92253
(760Y777-�. �� ��i� �°�• Lic. 'No?6:6702285
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LICENSED CONTRACTOR'S DECLARATION. - WORKER'S COMPENSATION DECLARATION
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 7000) of Division 3 of the Business and Professionals 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
License Class: B License No.: 672285. for by Section 3700 of the Labor Code, for the performance of the work for which-this permit is
issued.
Date: AI 6� ntractor. I have and will maintain workers' compensation insurance, as re4uired 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: - -
hereby affirm under penalty of perjury that I am exempt from the'Contractor's State License taw for.the' Carrier AMERICAN HOME Policy Number 1247619
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 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 - person in any manner so as to beco subject to the 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 agree that, if I should becomes ject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business Professions Codel'or 3700 of the L I shall fo ith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by f
"- any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (55001.: te: �{ % �! plic -
(_ 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 WARNING: FAILURE TO SECURE WORKERS' 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.). - - - APPLICANT ACKNOWLEDGEMENT
(._ 1 I, as owner of the property,, am exclusively contracting with licensed contractors to construct the project (Seca IMPORTANT Application is hereby made to the Director of Building and, Safety for a permit subject to the
7044, Business and Professions Cade: The Contractors' State License taw does not apply to an owner of conditions and restrictions set forth on this application. -
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made,. each: person at whose request and for
pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , B.&P.C. for this reason_ - the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless. the City -
- - - - of La Ouinta; its officers, agents and employees for any act or omission related to the work being
performed under or'following issuance of this permit. -
Date: - Owner: - •' 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
CONSTRUCTION LENDING AGENCY - _permit to cancellation.
I hereby affirm under penalty. of perjury that there is a construction lending agency for. the performance of the I certify that I have read this application and state that the above informat n is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to build .constructio , and hereby authorize representatives .
of thi c�to enter upon t above-mentioned pro r inspectio purposes.
Lender's Name:. a _ -
" Date: gnature (Applicant or Age •
Lender's Address: --
LQPERMIT - - `
Application Number 05
=000042:02
Permit . . . . . WALL/FENCE
PERMIT.
Additional,desc .
Permit'. Fee 54.00
Plan Check.Fee
00
Issue Date:..
Valuation .; .
.2400
Expiration Date 3/19/06
Qty, Unit Charge Per
Extension' .
BASE
FEE
45.00
1:00 9.0000' THOU_ BLDG
2,:001-25,000'.
9.00''..
Special Notes and Comments`
_
150 L.F. 31 RETAINING WALL, ORCO
SYSTEM-
YSTEM-Fee
Feesummary '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•
54.0.0
LQPERMIT