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05-5382 (BLCK) (III II I I I III VIII(III 01 • IE �/ P.O. BOX 1504 1 Tit�v 4----� ^� VOICE(760) 777-7012 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: ", 05-00005382 Owner: Property Address: 8.0.873 CALLE AZUL PUERTA AZUL PARTNERS APN: 762-240-003-54 -300962= 17700 SW UPPER BOONES FERRY RD Application description: WALL/FENCE SUITE 100 Property Zoning: MEDIUM DENSITY RES PORTLAND, OR 97224 Application valuation: 650 O DA Contractor: Applicant: Architect or Engin DEC DAVIS/REED CONSTRUCTION INC 2 2 2005 169 SAXONY ROAD, SUITE 105 ENCINITAS, CA 92024 CITY OF LA QUINTA (760)634-2350 FINANCE DEPT. Lic. No. : 813480 ------ ------------ ---- ---- -- =---- ------ ------ -------------------------------------------------- LICENSED C CTOR'S DECLA N WORKER'S COMPENSATION DECLARATION her y affirm u er penalty of p ury that 1 am li n d, er provision Chapter 9(commencing with I hereby affirm under penalty of perjury one.of the following declarations: Se ion 70001 Divi ' of t Business a. r a ode, my License is in full force and effect. _ I have and will maintain a certificate of consent to self-insure for workers'compensation,as provided cense Cla B Lice o.: 813480 for by,Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Factor: I have and ill maintain workers'compensation insurance,as re u' y�ectio 3700 of the Labor Code, or the performance of the work.for which thi it is issued. My wor ers'compensation OWNER-BUILDER DECLARATION ! insu Z. carrier and polic number are: hereby affirm under penalty of ury that I am exempt from the Contractor's State License Law for the Carrier 3'ATE UND Pol' umber WC298892005 following reason(Sec.7031.5, usiness and Professions Code: Any city or county that requires a permit to _ Ice fy tha in tt a performance e w for which this permit is issue shall not employ any construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the `'`L. on i ny manners to bac bject to the workers'co nsation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State dd ahat,if I ould beco e t to the workers'c ensation provisions of Section License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 3700 of the L ode I I ions. 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).: ate: scant: (_) 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 WARNING: FAIL RE TO SECU WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL Contractors'State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL 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 DOLLARS($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_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 Coder 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 applica" ade,each person at w uest and for pursuant to the Contractors'State License Law.). whose benefit work is performed un r pursuant to any permit issued as a result his application, (_1 I am exempt under Sec. ,B.&P.C.for this reason the owner,and the applicant,a agrees to,and shall defend,indemnify and hold harm s the City of La Quinta,its officers,a is and employees for any act or omission related to the wor being performed under or folio ing issuance of this permit. Date: Owner: 2. Any permit issued as result of this application becomes nullvoid if work is not comp nced within 180 days fr date of issuance of suc rmi sation of work for 180 d ys will subject CONSTRUCTION LENDING AGENCY permit to cancellat n. 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 ap ication and to th a orm ' s corr agree to comply with all work for which this permit is issued(Sec.3097,Civ.C.). city and county ordinances and st aws atiar bus nstr o ereby authorize representatives of t 's county to enter upo the above- --'-``" Lender's Name: Date: ig9�wre•IAp cant r A Lender's Address: 4 r� LQPERMIT Application Number . . . . . 05-00005382 Permit . . WALL/FENCE PERMIT Additional desc . . Permit Fee 19.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 650 Expiration Date 6/07/06 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 2.0000 HND BLDG 501-2, 000 4.00 ---------------------------------------------------------------------------- Special Notes and Comments 26 L.F. 6' GARDEN WALL, ORCO SYSTEM Fee- summary Charged Paid Credited Due Permit Fee Total 19.00 .00 .00 19.00 Plan Check Total .00 .•00 .00 .00 Grand Total 19.00. .00 .00 19.00 LQPERMIT .