05-1268 (BLCK) IIIIII�IIIIIIIIIIIIIIIIII 34
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P.O. Box 1504
�,�'��� BUILDING & SAFETY DEPARTMENT
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(760).777-7012Tt�9 78-495 CALLS TAMPICO FAX (760)
777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . 05-00001268 Date 4/05/05
Property Address . . . . . . 80908 CALLE AZUL
APN: 762-240-003-33 300961-
Application description . . . WALL/FENCE
Property Zoning . . . . . . MEDIUM DENSITY RES
Application valuation . . . . 2338
Owner' Contractor
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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
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Permit WALL/FENCE PERMIT
Additional desc
Permit Fee 54 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 2338
Qty Unit Charge Per Extension
BASE FEE 45 . 00
1 . 00 9 . 0000 THOU BLDG 2 , 001-25, 000 9 . 00
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Special Notes and Comments
70 L. F. 2 ' GARDEN WALL, 108 L. F. 5 '
GARDEN WALL, BOTH ORCO SYSTEM
Fee summary 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 . 00
D Q
APR 13 1005
Clry Qs QUINTA
FIN Ne (JE
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: Date:1--22.2
Applicant: Architect or Engineer:
Applicant's Mailing Address: Architect or Engineer's Address:
on AtOW
AJ ��
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLA5ATION
I hereby affirm under pen f perjury that I am licensed under provisions of ChapJer 9(cgmme n th$Action 7000)of Division 3 of the Business and Professionals
de,and License is in ul1 rce and effect. l hCG_ _1�`Jl1
License CI sZ ense No.
Al-,-/Dateontractor
OWNER-BUILDER DECLARATION
I he eby affi under penalty of perjurythat 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 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 work for which this permit is issued.
791 have and WMiTURtain workers'compensation insurance,as required by Seck'o_n 3700 of the Labor Code,Xnvnmanner
performance of the work for ich this permit is
issu_ . y workers'compensation ins nce carrier and policy number ar�j� /�� -Z
arner icy Number "'����/// G/�,/ /7
_I certif tha in the performance of rk for permit is issue t employ a pefserfi so as to be a subject to the workers'
c pensatio laws of an a tha ' should beco s ject to the w compensation provisions of Section 700 of the Labor Code,1 shall
hwith c pl those prr ons.
Date pp' ant /
WARN/INES
FAI RE TO SECU OR ION COVERAGE IS UNLAWFUL,AND SHALL SUBJECT AW-EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL 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 a
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 Ouinta,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 beco v of commenced within 180 days from date of issuance of such permit,or
cessation of work for 180 days will subject per . cancellatio
I certify that I hav read thi pplication an above info i s correct. I agree to comp hall ounty ordinances and state laws relating to building
construction,a herebyy uthod presentatives his count r upon the ab e-m tioned inspection purposes.
Date (/ ignature(Applican or nt):