05-4204 (BLCK)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; :
-
9'/20/05.
Application Number:- 05 00.004204„ _:i Owner. -"
C
Date:
t�
-'Property: Address: 81225 VICTORIA LN: SHEA LA QUINTA'
APN: 764:-270-999-129 -300234- C/O JEFF MCQUEEN
Application description:' .WALL/FENCE
8,800'N GAINEY CENTER 35.0
Property Zoning: MEDIUM "HIGH DENSITY RES SCOTTSDALE, .AZ 85258
Application valuation:. 880 ,
DContractor:
Applicant: Architect or Engine OCT O' f 66l0� SHEA ,HOMES, INC:
81260 -AVENUE 62
LA QUINTA, CA 92253
-
LA (760)777-6005
/A Lic : No..: 672285. "
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LICENSED CONTRACTOR'S DECLARATIONWORKER'S"COMPENSATION DECLARATION -
- I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter (commencing with- I hereby affirm under "penalty of perjury one of the following declarations: ,
Section, 7000).of Division 3of the Busine sand Professionals. Code, and my License is in full force and effect. - � _ 'I haveandwill maintain a. certificate of consent to self -insure for workers' compensation, asprovided
License -Class: E1 License No.: 672285 - for by Section 3700, of the Labor Code, for the performance of. the work for which this permit is "
r issued.
ate: arector: 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 workerscompensation
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 Law 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 Iissuance, also requires the applicant for the - person in any manner so as to becom ubject.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 shout ecomes j ct to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Lab e; I hall fo rth 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
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date: (�7 (� Applican - -
(_ 1 I, as owner of the property, or my employees with wages as their sale 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 hot. 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 (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for apermit subject to the
7044, Business and Professions Code: The Contractors' State License Law 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 contractors) 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 anypermit,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 Quinta, its officers, agents and employees for any actor 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 nulland void if work is not commenced
within 180 days from date of issuance of such permit, or cessation 'ofwork 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 infor ation 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 b 'ding constr ion, and hereby authorize representatives
" - - of this county to enter upon the above-mentioned - for i tion purposes. -
_ Lender's Name: r '
. Date: -9—Signature (Applicant or -A - -.
Lender's Address: - - -
LQPERMIT
Application Number 05-00004204'
Permit .WALL/FENCE :PERMIT _.
Additional desc.
•
Permit Fee 23..0 0:.. - Plan Check Fee :
... .00`
Issue Date "Valuation . .
88.0
Expiration Date 3/19/06
;`Qty Unit Charge Per
Extension
BASE FEE -
15.00
4--.. 2.001,00-HND BLDG 501-2,000
8.00
Special Notes and Comments
55'L.F. 3' RETAINING WALL, 'ORCO SYSTEM
Fee summary Charged Paid,Credited
Due
Permit Fee Total' 23.00 :00 00
23100
• Plaft Check Total-...00.00 . . 00
; 00
,Grand -Total 23.:00.' .00 .00
•23:00