04-7673 (BLCK) r I IIIIIII VIII III VIII IIII 58
t Q, 1E
°� � • �`� �
U Cr�
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
OF9 78-495 CALLE TAMPICO . FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . 04 0-00b76 7 Date 12/08/04
Property Address . . . . .. . 80926 CALLE AZUL
APN: 762-240-003-30 -300961-
Application description WALL/FENCE
Property Zoning . . . . . . . MEDIUM DENSITY RES
Application valuation 2728
Owner Contractor
———————————————————————— a ---------------—————————
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
--------------------------------------------------------------------------- -
Permit . . . . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 54 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 2728
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
126 L. F. 5 ' GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- .----7-----
Permit Fee Total 54 . 00 . 00 F . 00 54 . 00
Plan Che.ck Total . 00 .. 00 . 00 . 00
Grand Total 54 . 00 00 . 00 54 . 00
ti I
C-C 09 2004
CITY OF IAQUINT4
FINANCE DEPT.
P.O. BOX 1504 • .
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: tog- 10-3 Date:
Applicant: Architect or Engineer:
Applicant's Mailing Address: Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of C ter 9(comme ing with Section 7000)of Division 3 of the Business and Professionals
iCode,and my License' full force and effect.
// License Class icense No.
/ Date ��ontractor
OWNER-BUILDER DECLARATION
I hereby f
Z nder 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 awn 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 1,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 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 wo which this permit is issued.
�I ha an will aintain workers'compensation insurance,as required b S cyn 3700 of the Labor Code,for the performan f the work for which this permit is
ssued workers'compensation' u craFi a cameTaa policy nui�j �-�p
/Carrier olicy Number 111fff��— p V�
l _I cpioflfy tha,in the perfo ce of the work for which perm is issued,I shall not em oy a y p n any mann so as to become subject to the workers'
co p nsatio I laws alifomia,and a e that,' sh d b come subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall
f ('th coco]mply wit those provisio
/Date Applicant _
WARNI FAILURE TO SECURE WO ERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL N S 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 wh and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application,the owner,and the ap ' , achnt h aggrreees to,and sha , fend,indemnify and hold harmless the City of La Ouinta,its
officers,agents and employees for any act or omissi ated to the work being performed unde or following issuance of this permit.
2. Any permit issued as a result of this application comes null and voi work is not commenced 'thin 180 days from date of issuance of such permit,or
cessation of work for 180 days will subject pe it to cancellation.
I certify that I hav fie this application and state that the informati correct. I a mply w' all city and county ordinances and state laws relating to building
construction,an he by adthorize representatives of this county o e abov oned p erty for inspection purposes.
/ ate / mature(Applicant or Agent):