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P.O. BOX 1504 ----- ^� 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: �05-0_00053833 Owner:
Property Address: 80879 CALLE AZUL PUERTA AZUL PARTNERS
APN: 762-240-003-55 -300962- 17700 SW UPPER BOONES FERRY RD
Application description: WALL/FENCE SUITE 100
Property Zoning: MEDIUM DENSITY RES D PORTLAND, OR 97224
Application valuation: 720
DEC 2 2 2005 Contractor:
Applicant: Architect or En ine r: DAVIS/REED CONSTRUCTION INC
CITY or LAQUINTA 169 SAXONY ROAD, SUITE 105
FINANCE DEPT- ENCINITAS, CA 92024
(760)634-2350
Lic. No. : 813480
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LICENSED CONTRACTOR'S ECLARATION WORKER'S COMPENSATION DECLARATION
I h rely vm under pen y of perjury that I am lic sed under pro sions of Chapter 9(com ith�'— I hereby affirm under penalty of perjury one of the followingdeclarations:
S do 70001 of Divisi 3 of the Business and P ionaIs Co,
o ,and m in ull force and effect. _ I have and will maintain a certificate of consent to self-insure for workers'compensation,as provided
L' nse Class: B L' 13480 for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
issued.
rector: I have and will maintain workers'compensation insurance as required by Section 3700 of the Labor
111 Code,for the performance oft or which this permit is 1 My workers'compensation
WN -BUILDER DECLARATION insurance carrier and number are:
I hereby affirm under penalty of perjury th am exempt from the Contractor's State License Law for the Carrier STATFV F Policy N er WC298892005
following reason(Sec.7031.5,Business d Professions Code: Any city or county that requires a permit to _ I ertify t t,' e perfor nce of the for which this permit is issued,I shal not employ any
construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the perso any er so as to be a subject to the workers'compensation s of California,
permit to file a signed statement that he'or she is licensed pursuant to the provisions of the Contractor's State and gre t,if I should be a}�jec to the workers'compensatioyp visions of Section
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 37 the Labor Code a R comply with those pro '' nits.
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).: p nt:
(_) 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 WA ING: AILD E TO CU KERS'CO NSATION COVERAGE IS UNLAWFUL,AND SHALL
Contractors'State License Law does not apply to an owner of property who builds or improves thereon, SU JECT N EMPLOYER TO 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 - DO LAR ($100,000). IN 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 I,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 contractors)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_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 r k being
performed under or following issuance of this permit.
Date: Owner: 2. Any permit issued as a result of this application as null and void if work is not commenced
within 180 days from date of issuance of c permit,or cessation of work for 180 days will subject
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and stat that the above information is rrect. I agree to comply with all
work for which this permit is issued(Sec.3097,Civ.C.). city and county ordinances and state laws relating to-building co r e presentatives
of this my to enter upon the above-mentioned property for inspecti ur
Lender's Name:
ate: ature(Applicant or Agent):
Lender's Address: F� /
LQPERMIT
Application Number . . . . . 05-00005383 .
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 21.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 720
Expiration Date 6/07/06
Qty Unit Charge -Per Extension
BASE FEE 15.00
3.00 2.0000 HND BLDG 501-2,000 6.00
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Special Notes and Comments
16 L.F. 6' GARDEN WALL, 20 L.F. 4-
GARDEN WALL, ' BOTH ORCO SYSTEM
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 21.00 .00 .00 21.00
Plan Check Total .00 .00 ..00 .00
Grand Total 21.00 .00 .00 21.00
LQPERMIT