05-1275 (BLCK) u�n�' IIIIIIIIIIIIIIIIIIIIIIIII 16
2
La. c - iE
� y
44; & SAFETY DEPARTMENT
Cwt P.O. BOX 1504 (760).777-7012
FTt�9 78-495 CALLE TAMPICO
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . 05-000'01275 Date 4/05/05
Property Address . . . . . . 80891 CALLE AZUL
APN: 762-240-003-36 -300961-
Application description WALL/FENCE
Property Zoning . . . . . . . MEDIUM DENSITY RES
Application valuation . . . . 1516
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
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Permit . . . . . . WALL/FENCE PERMIT
Additional desc
Permit Fee . . . . 37 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 1516
Qty Unit Charge Per Extension
BASE FEE 15 . 00
11 . 00 2 . 0000 HND BLDG 501-2 , 000 22 . 00
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Special Notes and Comments
70 L. F. 5 ' GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid Credited. Due *
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 37 . 00 . 00 . 00 37 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 37 . 00 . 00 . 00 37 . 00
r
APR 13 105
CITY OF�q QuiNTA
FINANCE DEPT
P.O. Boa 1504 • /i •
w V OICE (760) 777-7012
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT �L
Application Number: Q 5- 14.7$ . Date:
Applicant: Architect or Engineer:
Applicant's Mailing Address: Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONZ RAI MN
I hereby affirm under, ty of perjury that I am licensed under rovi ' a e i 0 f,the Business and Professionals
de,and my Lice �e is' I force and effect.
License Class -L�e No.
�6ate tractor l
OWNER-BUILDER DECLARATION
I hereby ffirm 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(5500).):
U 1,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
hereby affirm under penalty of perjury one of the following declara:ions:
I have and will maintain a certificate of consent to self-i-isure for workers'compensation,as provided for by Section 3700 of the Labor Code,for the performance
of the work LqLghich this permit is issued.
I have and yAl mainflain workers'compensation i ran equired by Section 3700 of the Labor Code,for the PTnance of the wogLabor
this permit is
is d. ers'compensation i ce carrier and polic umber are: /.2 "� C� �j
arrier olicy Number l/lj< `
I c that, n the performance the work for w ' this permi su ,I shall not employ any pers .n manner so as to beco e workers'
compe ation laws of Califo ia,and agree t,if I shout eco a su ject to the workers'compensation provisions of Section 37 oCode,I shall
forth h comply with those pro
�te Applicant
WAR NG: AILURE TO SECURE WORKER COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVI FINE UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
SE ION 706 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 Ouinta,its
officers,agents and employees for any act or omission related to t k�eing pet\formed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes and void if work is not commenced within 180 days from date of issuance of such permit,or
cessation f work for 180 days will subject permit t ncellation4enteron
I certify that I have thi application and state that the ve inrrect. I agree to c•mply with all city and county ordinances and state laws relating to building
construction,an ereb uthorize representatives of this ounty toa above-menti ed property for inspection purposes.
Date Signature(Applicant or Agent):