05-5362 (BLCK) "` IIIIIIIIIilllllllllllllll 54
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: 12/08/05
Application Number: 05-00005362 \1 Owner:
Property Address: `-80843 CALLE AZUL PUERTA AZUL PARTNERS
APN: 762-240-003-49 -300962- 17700 SW UPPER BOONES FERRY RD
Application description: WALL/FENCE D SUITE 100
Property Zoning: MEDIUM DENSITY RES PORTLAND, OR 97224
Application valuation: 1050 2 2005
DECCly Contractor:
Applicant: Architect or Engi eer: CITY OF LAQUINTA DAVIS/REED CONSTRUCTION INC
FINANCE DEPT. 169 SAXONY ROAD, SUITE 105
ENCINITAS, CA 92024
(760)634-2350
Lic. No. : 813480
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./J I NSE ONTRACTORS' DECLAR O --_ WORKER'S COMPENSATION DECLARATION
✓�Ilgfs a ir• under p ally of p I t I a censed under prov' ' apter 9(commencing with I hereby affirm under penalty of perjury one of the following declarations:
ecti 70 1 of Divi ion 3 of t si ss a rofessio e, 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
Lice a Class: BLice o.: 813480 for by Section 3700'of the Labor Code,for the performance of the work for which this permit is
k issued. -•
D te: on L`I have and will maintain worker compensation insurance,as required b ection 3700 of the Labor
Code,for the perf ance of the work for which this permit is issued. M1t workers'compensation
OWNER-BUILDER DECLARATION 'fisurance car' r and policy number are: \
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier ST F Policy b r WC298892005
following reason(Sec.7031.5,Business and Professions Code: Any city or county that requires a permit to I certif at,in the perfo ..ance of th wh' h this permit is issued,)1sall not employ any
construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the p s in ner so as to j the workers'compensalaws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State nd re rs'compensatio isions of Section
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 0 of the Labor Cod h comply with those pro
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 licant:
(_) 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: FAILURE TO SE E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL
Contractors'State License Law does not apply to an owner of property who builds or improves thereon, Su JECT AN EMPLOYER 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 LLARS($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 ECTION 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 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.l. 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 related to the work being
performed under or following issuanceof thi pe
-
Date: Owner: 2. Any permit issued as a result of this p cation becomes null and void if wor not commenced
within 180 days from date uance of such permit,or cessation of work for i days will subject
CONSTRUCTION LENDING AGENCY perm: 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 e read pis
a cation and state that the above information is rr . I agree to omply with all
work for which this permit is issued(Sec.3097,Civ.C.). city and cou y ordina es an state laws relating to building construction, d eby authorize resentatives
of is co ty to en upon the -mentioned property for i o u ses.
Lender's Name:
Si nature(Applicant or Agent):
Lender's Address:
LQPERMIT
CAW
Application Number . . . . . 05-00005362
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 27.00 Plan Check Fee 00
Issue Date . . . . Valuation . . . . 1050
Expiration Date 6/06/06
Qty Unit Charge Per Extension
BASE FEE 15.00
6.00 2 .0000 HIND BLDG 501•-2, 000 12.00
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Special Notes and Comments
42 L.F. 6' GARDEN WALL, ORCO SYSTEM
Fee summary Charged . Paid Credited Due
--=-------------- ---------- ---------- ---------- ----------
Permit Fee Total 27.00 .00 .00 27.00
Plan Check Total .00 ..00 .00 .00
Grand Total 27.00 .00 .00 27.00
LQPERMIT