05-1271 (BLCK) IIIIIII VIII III VIII IIII 62
o� Ot
u �,tcv
BUILDING & SAFETY DEPARTMENT
CF ` w� P.O. Box 1504 v: (760) 777-7012
` OFTt� 78-495 CALLS TAM PICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . . i05-00001271 ; Date 4/05/05
Property Address . . . . . . 80927 CALLE AZUL
APN: 762-240-003-42 -30.0961-
Application description . . . WALL/FENCE
Property Zoning .. . . . . . . MEDIUM DENSITY RES
Application valuation. . 1039
Owner Contractor
------------------------- ------------------------
PUERTA AZUL PARTNERS DAVIS/REED CONSTRUCTION INC
17700 SW UPPER BOONES FERRY RD 169 SAXONY ROAD, STE #105
SUITE 100 ENCINITAS CA 92024
PORTLAND OR 97224 (760) 634-2350
WCC: STATE FUND
WC: WC298892004 06/12/05
CSLB: 813480 10/31/06
CCC: B
-----------------------------------------------------------------7----------
Permit . . . . . WALL/FENCE PERMIT
Additional desc
Permit Fee . . . . 27 . 00 Plan Check Fee 00
Issue Date . . . . Valuation . . . . 1039
Qty Unit Charge Per Extension
BASE FEE 15 . 00
6 . 00 . 2 . 0000 HND BLDG 501-2 , 000 12 . 00
-------------------------------------------------------------------------=--
Special Notes .and Comments
48 L. F. 5 ' GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid Credited Due
----------------- ---------- -7-------- ------- ----------
Permit Fee Total 27 . 00 . 00 . 00 27 . 00
Plan Check Total . 00 QO . 00 . 00
Grand Total 27 . 00 . 00 . 00 27. 00
APR 13 2005
CITY OF LA QUINTA
FINANCE DEPT
P.O. BOX 1504 •
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: as- /.27 Date:A '121• OS
Applicant: Architect or Engineer:
Applicant's Mailing Address: Architect or Engineer's Address:
�900N
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under pen of perjury that I am licensed under provisions of Ch t r 9(commencin s ct)7000)of Division 3 of the Business and Professionals
Code,and my icense Win l orce and effect. �
nse CI�s cense No.
r
/Date �ontrctor
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors'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 Contractors'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).):
U 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 or 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.).
U 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.).
U I am exempt under Sec. BA P.C.for this reason
Date Owner
WORKERS'COMPENSATION DECLARATION
I hereby affirm under penally 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.
ave and will�aa'mtain workers'compensation insurance,as required by Section 3700 of the Labor Co e,for erformance of they6rk for which this permit is
issu M workers'compensation i nce carrier and policy number ar : n /
�drrier olicy Number
/ _I cert at,' the performance of the or which it is issued,I shall not employ any person in any manner so as Abbecome subject to the workers'
co pe ation laws of Californi d agree tha ould become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall
orth ith comply with those visions.
to L
.P'plicant
WARNIN F ILURE TO SECURE WOR '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.
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
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 can on.
I certify that I hay ad t is application and state that the abo nformation is co ect. I agree to comply with all city and county ordinances and state laws relating to building
construc`ttii nn,,a here aut o' representatives of this c my t ter upon t above-mentioned property for inspection purposes.
/ate ( ��&'PXg_nat.re(Applicant or Age