05-4386 (BLCK) 11111111111111111152 }
I 1111111 IE
P.O. BOX 1504 �� — 4 '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: 9/29/05
Application Number: 05-00004386 Owner:
Property Address: 80842 CALLE AZUL PUERTA AZUL PARTNERS
APN: 762-240-003-65 -300962.- D d17700 SW UPPER BOONES FERRY RD
Application description: WALL/FENCE SUITE 100
Property Zoning: MEDIUM DENSITY RES PORTLAND, OR 97224
Application valuation: 1550 nrT
_ 7 005 Contractor:
Applicant: Architect or Engine C'��P DAVIS/REED CONSTRUCTION INC
Q Vll�jq 169 SAXONY ROAD, SUITE 105
E� ENCINITAS, CA 92024
(760)634-2350
Lic. No. : 813480
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EN CONT CTO ECLARATION WORKER'S COMPENSATION DECLARATION
I here affir under nalty of perjury t t I a i sed u rovisions of Chapter 9(commencing with I hereby affirm under penalty of perjury one of the following declarations: .
Sectio 700 of D' sion 3 of the Busi ss and ssio s Code,and my License is in full force and effect. _ I have and will maintain a certificate of consent to self-insur r workers'compensation,,as provided
L' a as License No.: 813480 "for by Section 0 of\the Labor Code,for the perfor nce of the work for which this permit is '
issued. 1
D t�, S4ntractor: I have and w' m tain wo kers'compensation i rance,as required by Section 3700 of the Labor
Code,f the rforman a of the work for ich this permit is issued. My workers'compensation
ER-BUILDER DECLARATION insure a ca ier and po cy number are"
Ihere a under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier T TE F Pol' Number WC298892005
followi I rea n(Sec.7031.5,Business and Professions Code: Any city or county that requires a permit to _ certify that,' e perfor, ance of a work for which this permit is issued,I shall not employ any
constr t,alt ,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the son in n m nner o as t ecome subject to the workers'compensation laws of California,
permit file signed statement that he or she is licensed pursuant to the provisions of the Contractor's State �a d gree he,i I sh Id come subject to the workers'compensation provisions'of Section
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or I ps7 of r C ,I shall forthwith comply with those provisions.
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).: _ App ca
(._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 WI G: [LURE TO SEC WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND•SHALL
Contractors'State License Law does not apply to an owner of property who builds or improves thereon, S BJE AN 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 DOLLARS IS1 0,000). 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 condition and restrictions set forth on this application.
property who builds or improves thereon,and who contracts for the projects with a contractor(s)licensed Each person pon whose behalf this application is made,each person at whose request and for
pursuant to the Contractors'State License Law.). whose be efit work is performed under or pursuant to any permit issued as a result of this application,
I—) I am exempt under Sec. ,B.&P.C.for this reason the ow r,and the applicant,each agrees to,and shall defend,indemnify and hold harmless the City
of La uinta,its officers,agents and emplo,ees for any act or omission related to the work being
pert med under Or following issuance of is p rmit.
Date: Owner: An permit issued as a result of this app cation comes null and void if work is not commenced
within 180 days from date of issuanc of such p rmit,or cessation of work for 180 days will subject
CONSTRUCTION LENDING AGENCY er to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the Ice if t av read this application and state at t abo a information is correct. gree to comply with all
work for which this permit is issued(Sec.3097,Civ.C.). a u o dinances and state laws relating o b ing onstruction,and y authorize representatives
f t i c u t enter upon t above-mentioned op y f r inspectio oses.
Lender's Name:
to ' nature(Applicant or Agent)
Lender's Address: t
LQPERMff .
Application Number . . . . . . 05-00004386
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 37.00 Plan Check Fee 00
Issue Date . . . . Valuation . . . . 1550
Expiration Date 3/28/06
Qty Unit Charge Per Extension
BASE FEE 15.00
11.00 2.0000 HND BLDG 501-2, 000 22.00
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Special Notes and Comments
62 L.F. 6' & 65 L.F. 2 ' BLOCK WALLS,
BOTH ORCO SYSTEM
Fee summary Charged Paid Credited Due
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Permit Fee Total 37.00 .00 .00 37.00
Plan Check Total .00 .00 .00 .00
Grand Total 37.00 .00 .00 . 37.00
LQPERMIT .