05-5388 (BLCK) IIIIIIIIIIIIIIIIIIIIIIIII 13 1
P.O. BOX 1504 -- 1E -- f 44OW4
VOICE(760)777-7012
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78-495 CALLE TAMPICO FAX(760)777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING&SAFETY DEPARTMENT INSPECTIONS(760)777-7153
BUILDING PERMIT
_ Date: 12/09/05
Application Number: C05-00005388 Owner:
Property Address: 80890 CALLE AZUL PUERTA AZUL PARTNERS
APN: 762-240-003-57 -300962- 17700 SW UPPER BOONES FERRY RD
Application description: WALL/FENCE SUITE 100
Property Zoning: MEDIUM DENSITY RES PORTLAND, OR 97224
Application valuation: 3100 1O
DEC 2 2 2005 Contractor:
Applicant: Architect or E n er: DAVIS/REED CONSTRUCTION INC
CITY Of LppU1NTA 169 SAXONY ROAD, SUITE 105
C
TYCE DEPT ENCINITAS, CA. 92024
(760)634-2350
Lic. No. : 813480
LICENSE TRACTO DECLA TION WORKER'S COMPENSATION DECLARATION
I her by affir under pen of perjury that I am c sed der ovisions o apter 9(c mmencing with I hereby affirm under penalty of perjury one of the following declarations:
Sec ion 700 1 of Djyi 1 3 of the Busines Pr es al de,and icense is i full force and effect. _ e-and will maintain a certificate of consent to self-insure for workers'compensation,as provided
Lic nse Cie s: B cense N 13480 for by Section 3700 of the Labor.Code,yor-the performance of the work for which this permit is
issued.
Co`ntractnt• I have and willmain orkersation insurance,as required by Section 3700 of the Labor
Code,fort erformance of the work for which this permit is issued. My workers'compensation
OWNE -BUILDER DECLARATION insura carrier and policy number are:
hereb affirm under penalty of p lur at I am exempt from the Contractor's State License Law for the Carrier ST Policy Nu WC2. 8892005 �1
follow ng reason(Sec.7031.5,Business and Professions Code: Any city or county that requires a permit to I ce if that,in the rmance of the w whi is permit is issued,I spall not employ any
construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the pe manner so as to b co jec he workers'compensate laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State d ree that,i sou c e of Section
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 7 of the Labor Code sl i comply with those provisio
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)": at plicant:
(_1 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 W RNI FAILURE TO S KERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL
Contractors'State License Law does not apply to an owner of property who builds or improves thereon, BJE TAN EMPLOYE IMINAL 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 OLL RS($100,000). 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,AND 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 1,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 request and for
pursuant to the Contractors'State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_1 I am exempt under Sec. ,B.&P.C.for this reason 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.
Date: Owner: 2. Any permit issued as a result of this appli ' ecomes null and void if work is not commenced—
within 180 days from date of iss a of such permit,or ces A�ofor�e��e 180 days will subject
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency far the performance of the I certify that I have read this appticationan state that the above n iagall
work for which this permit is issued(Sec.3097,Civ.C.). cityandc my ord'rTances and state laws re to buildin on d hereby authtatives
of this c unty t;hter upon eabove-mentioned prop
Lender's Name:
Dat gnature(Applicant or A t
Lender's Address:
LQPERMIT
Application Number . . . 05-00005388
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 63 .00 Plan Check Fee .00
Issue Date . . Valuation . . . . 3100
Expiration Date 6/07/06
Qty Unit Charge Per Extension
BASE FEE 45.00
2.00 9.0000 THOU BLDG 2, 001-25,000 18.00
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Special Notes and Comments
124 L.F. 6' GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 63.00 .00 .00 63 .00.
Plan Check Total .00 ._00 .00 .00
Grand Total 63.00 .00 .00 63.00
LQPERMIT