05-4387 (BLCK) ' ' I IIIIIIIIIIIIIIIIIIIIIIII 47 `fitit
P.O. BOX 1504 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: 05700004387 Owner:
Property Address: 80836 CALLE AZUL PUERTA AZUL PARTNERS
APN: 762-240-003-66 -300962- 17700- SW UPPER BOONES FERRY RD
Application description: WALL/FENCE SUITE 100
Property Zoning: MEDIUM DENSITY RES D PORTLAND, OR 97224
Application valuation: 2000
nrT 17 Contractor:
Applicant: Architect or Engine r: DAVIS/REED CONSTRUCTION INC
�� ®I ��I�-VA -- 169 SAXONY ROAD, SUITE 105
�iF�AILAQUIN ENCINITAS, CA 92024
I^ (760)634-2350
Lic. No. : 813480
CENSED CONTRACT ECLARATION WORKER'S COMPENSATION DECLARATION
I here affi mu er enal[y# erjl'+ry the I am licensed r provisions of Chapter 9(commencing with I hereby affirm under penalty of perjury one of the following declarations:
.
Sectio 70 )o Div Sion 3 1 sine and Profe nals Code,and 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 s: License No.: 813480 for by Section 3700 of the Labor Code, r-the performance of the work for which this permit is
issued.
Contra I have and will maintain workers'c pensatio insurance,as required by Section 370.0 of the Labor
Code,for the performance of a work for hich this permit is issued. My wo 'compensation
OWNER-BUILDER DECLARATION i uranca carrier and polic number are:
I here y ffir i under penalty erjury that I am exempt from the Contractor's State License Law for the Carrier ST T FUND Policy umb 92005
follows g reason(Sec.7031.5,Business and Professions Code: Any city or county that requires a permit to I c rtif at,in the performa or which this permit is issued,1 shall not employ any
constr ,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the pe on in any manner so to be me subject to the workers'compensation 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 that,if I sho eco a 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 700 of the L C I 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).: a ! pplicant:
(_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 WA I FAILURE 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, SUB E AN EMPLOYER TO C 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 DO S 1$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 SE ION 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,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,
(_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 office is and employees for any act or omission related to the work being
pert rmed u r following issuance oft is permit.
Date: Owner: 2 An per ' issued as a result of this ap tion becomes null and void if work is not commenced
w hin 80 days from date of issua such permit,or cessation of work for 180 days will subject
CONSTRUCTION LENDING AGENCY rmit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I c rtif that av ead this application and s th above informatio om_ply with all
work for which this permit is issued(Sec.3097,Civ.C.). i y a c or nances and state laws re b ding c on,and hereby authorize representatives
i ter upon th bove-menti or inspection purposes.
Lender's Name: � '
i
ature(Applicant nt):
Lender's Address:
LQPERMIT .
1`
Application Number . . . 05-00004387
Permit WALL/FENCE PERMIT
Additional desc
Permit Fee 45.00 Plan Check Fee .00
Issue Date Valuation . . . . 2000
Expiration Date 3/28/06
•Qty Unit Charge Per Extension
BASE FEE 15.00
15.00 2.0000 HND BLDG 501-2,000 30.00
----------------------------------------------------------
Special Notes and Comments
82 L.F. 6' & 56 L.F. 2' BLOCK WALLS,
BOTH ORCO SYSTEM
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 45.00 .00 .00 4.5.00
Plan Check Total .00 .00 .00 .00
Grand Total 45.00 .00 .00 45.00
LQPERMIT