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05-5379 (BLCK) 70 1R. P.O. BOX 1504 IE I ce4iy�, 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: r 05-00005379" Owner: Property Address: 80861 CALLE AZUL PUERTA AZUL PARTNERS APN: 762-240-003-52 -300962- 17700 SW UPPER BOONES FERRY RD Application description: WALL/FENCE SUITE 100 Property Zoning: MEDIUM DENSITY RES PORTLAND, OR 97224 Application valuation: 920 Contractor: Applicant: Architect or En I� r: DAVIS/REED CONSTRUCTION INC v 169 SAXONY ROAD, SUITE 105 . DEC 2 2 2005 ENCINITAS, CA 92024 (760)634-2350 Lic. No. : 813480 CITY OF LA QUINTA FINANCE DEPT -- --------- — — ------ -- -------- - - -- ------------------------------- ------ ----—------------- — ----- UCEN CONTRACTOR'S DE ATION WORKER'S COMPENSATION DECLARATION I hereb affirm u at penal[ of perjury that li nsed under prov'' ns of Chapter 9(commencing with I hereby affirm under penalty of perjury one of the following declarations: Secti 7000) Di ' 3o a Busin essionals a and ffact. I have and will maintain a certificate of consent to self-insure for workers'compensation,as provided Lice a Clas icense No.: 813480 _ for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. t ontractor• I have and will maintain workers'compensation insurance,as required by Section 3700 of the labor Code,for the perfor a work for w is mit is issued. My workers'compensation OWNER-BUILDER DECLARATION - insurance c and policy number are: I her y affirm under penalt of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Polic umber WC298892 5 foil ing reason(Sec.7031.5,Business and Professions Code: Any city or county that requires a permit to _ I ce y tha the performance of w ' this permit is iss ed,I shall not employ any construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the perso n any so as ubli( o the workers'compe'sation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State an gree ' I shou ib' o the workers'compensa' n provisions of Section License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or / 0 the Labor C t o it p ith those pr ions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by L any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).: t plica 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 AR G: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND S Contractors'State License Law does not apply to an owner of property who builds or improves thereon, SU ECT 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 D 'LARS($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,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 th' plieation4s-made,-each-persson at whose request and for pursuant to the Contractors'State License Law.). whose benefit work is o med under or pursuant to any permit is s a result of this application, (_1 1 am exempt under Sec. ,B.&P.C.for this reason the owner,.and applicant,each agrees to,and shall defend,indemnify an -hamharmless the City of La Quinta,i officers,agents and employees for any act or omission related to th worit being performed under following issuance of this permit. \ Date: Owner: 2. Any permit issued as a f this application becomes null and void if work is not commenced' within 180 days from date of issu ch permit,or cessation ofwor or 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 1 certify that I have read this application and state that the abo i ati rect. I agree to mply with all work for which this permit is issued(Sec.3097,Civ.C.). city and county ordinances and state laws relating to buildi gru d here ri epresentatives of this county to enter upon the above-mentioned prop Fis purposes. Lender's Name: 3 ignature(Applicant or Age - Lender's Address: / N LQPERMIT Application Number . . . . 05-00005379 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 25.00 Plan Check Fee .00 Issue'Date . . . . Valuation . . . . 920 ° Expiration Date 6/07/06 ' Qty ' Unit Charge Per Extension BASE FEE 15.00 5.00 2 .0000 HND . BLDG 501-2,000 10.00 ---------------------------------------------------------------------------- Special Notes and Comments 24 L.F. 6' GARDEN WALL, 20 L.F. 4' GARDEN WALL, 8 L.F. 2 ' WALL, ALL ORCO SYSTEM Fee summary Charged Paid Credited Due - ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 25.00 .00 .00 25.00 Plan Check Total .00 .00 .00 .00 Grand Total 25.00 .00 .00 25.00 LQPERMIT .