05-5397 (BLCK) IIIIIII VIII III VIII IIII 68 •
P.O. BOX 1504 � --- IE � 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: 12/12/05
Application Number: X05-00005397 - Owner:
Property Address: 80860 CALLE-AZUL, PUERTA AZUL PARTNERS
APN: 762-240-003-62 -300962- 17700 SW UPPER BOONES FERRY RD
Application description: WALL/FENCE SUITE 100
Property Zoning: MEDIUM DENSITY RES PORTLAND, OR 97224
Application valuation: 2400
Contractor:
Applicant: Architect or Engi i DAVIS/REED .CONSTRUCTION INC
EDEC 2 2005 169 SAXONY ROAD, SUITE 105
ENCINITAS, CA 92024
(760)634-2350
CITY OF LA QUINTA Lic. No. : 813480
INANCE DEPT.
+I'Shereby
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�� LICENSED ACTO 7oE ON WORKER'S COMPENSATION DECLARATION
r y affeb irm under penalty o perjury that I am Ii n d under o inion me • g—Lh�_� I hereby affirm under penalty of perjury one of the following declarations:
tion 7000)of Division 3 of s e,an y License is in fu rce and effect. _ I have and will maintain a certificate of consent to self-insure for workers'compensation,as provided
rise Class: B rise 813480 for by Section 3700 of the Labor Code,for the perform k for which this permit is .
►/ issued.
e: C c or: K I have and will maintain workers'co
ion insurance,as required by Section 300 of the Labor
,Code,for the performance of ork for which this permit is issued. My worked.'compensation
OWNER-BUILDER DECLARATION i surance carrier and poli umber are:
affirm under penalty of peri hat I am exempt from the Contractor's State License Law for the Carr' STAT FUND Po icy Number WC29889yg• 5
wing reason ISec.7031.5,eusine s and Professions Code: Any city or county that requires a permit to _ certify n the rformance a work for which this mit' issued,I all no
construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the on in any anner so as ome subject to the or ion laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree th ,if I should a sub'e r e comp ion prov'sions of Section
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 3700 of the(Labor Cod ,1 with c ply th rov's'ons.
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 1$5001: 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 FINING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL
Contractors'State License Law does not apply to an owner of property who builds or improves thereon, UBJECT 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 ASPROVIDEDFOR 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 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,
am exempt under Sec. ,B.&P.C.for this reason the owner,and the applicant;each agrees to,and shall d ,' ¢PRfill�n Id harmless the City
of La Quinta,its officers,agents and employees ny act or omission related to a work being
performed under or following issuance of i permit.
Date: - Owner: 2. Any permit issued as a result of this ication becomes null and void if work is not ommenced
within 180 days from date of is ance of such Zpermit,orsation of work for 1 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 d state that the abon is corre . I agree to comply with all
work for which this permit is issued(Sec.3097,Civ.C.). city and county ordinances and state law relating to buildi and eby authorize representatives
of th' county o enter upon the above-men' ned prope 'fo ection p ones. -
Lender's Name:
e: Si ure(Applicant. _.
Lender's Address: f
LQPERMIT
t
r
Application Number . . . . 05-00005397
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 54.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 2400
Expiration Date 6/10/06
Qty Unit Charge Per Extension
BASE FEE 45.00
1.00 . 9.0000 THOU BLDG 2,001-25, 000 9.00
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Special Notes and Comments'
96 L.F. 6' GARDEN WALL, 45 L.F. 2 '
RETAINING WALL, BOTH ORCO SYSTEM .
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 54.00 .00 .00 54.00
Plan Check Total .00 .00 .00 .00 '
Grand Total 54.00 .00 .00 54..00
LQPERMIT - '