05-4203 (BLCK)P.O. BOX 1504.' VOICE (760) 777-7012
78495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA,CALIFORNIA 92253 BUILDING & SAFETY- DEPARTMENT INSPECTIONS (760) 777-7153
• BUILDING PERMIT
Dater 9/20/
_05
Application Number . 05 00004203 - Owner:
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Property, Address: 81213 VICTORIA LN.. SHEA LA QUINTA
APN: 764-270-999-128 -3002341- C/O JEFF MCQUEEN
Application description: WALL/FENCE J 8800 N GAINEY CENTER 350
Property Zoning: MEDIUM HIGH DENSITY -RES SCOTTSDALE, AZ 85258 .,
Application valuation: 880
OCT '071005
Contractor:
Applicant: Architect or En • ineer: CiTy OF SHEA HOMES, INC.
FltQhfli� j'� 81260 AVENUE 62
I�DI�j . LA QUINTA, CA. 92253
'(760) 777-6005: `
Lic. No..: 672285
.. � LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
- I 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 forceandeffect.- _ 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
I- - issued. -
atl� `�� 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 on
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 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 thew rk 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 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 should come su 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 Labor hall ith comply wit hose 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 (5500).: te: ` b licant: _
( ) I, as owner of the pioperty, 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 Lirense.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, -ANO 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 (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit 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 contractor(s) licensed 1 : Each person upon whose behalf this application is made, each person at;whose requestand for
pursuant to the Contractors' State License Law:). - whose benefit work is performed under or pursuantto any permit issued as a result of this application,
(_ 1 I -am exempt under Sec. , BAP.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 ce sationof 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 veinform on is correct. I agree to comply with all
•work for which this permit is issued 1Seo. 3097, Civ. C.1.. - - - city and county ordinances'andstate laws relating to b ' onstru n, and hereby authorize representatives
of this cou ty t enter upon the above-mentioned pr erty o nsp i S.
Lender's Name:-
(�. - ate �ignature (Applicant or Agent),
Lender's.ACdress:
LQPERMIT
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. Application, Number.. : ,. ". ; •05-000042.03
Permit .WALL/FENCE.PERMIT^
'"Additional desc
_
r' Permit Fee . ` + -23.00
Plan` Check`.Fee
00
Issue Date .
�' Valuation
r
880 ,-
Expiration.Date' 3/19/06
U Charge Unit Cha Per
Extension
- BASE
-
FEE
15.00;
- .4.00 2.0000 HND.,. ' BLDG
5-01-2, 000
8:F00
Special 'Notes" and Comments -
-55
8 5 L.F. 3 '-'� RETAINING WALL, ORCO
SYSTEM. -
' a :: Fee summary Charged .
-.Fee
Paid Credited
----- ----- - -
,Due
f
Permit Total 23 '00,
.00 .00. +-----23.00.
Plan. Check Total ,00•,
00 l :00.
.00
+,
.
Grand Total 23.00
v :00 .00
23.00
'
16
- . LQPERMIT. • • V i ' .. - - • _ 1 -
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