05-4388 (BLCK) ``y IIIIIIIIIIIDIIIVIIIIIII 43
IE �j
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: 05-00004388 - Owner:
Property Address: 80830 CALLE AZUL PUERTA AZUL PARTNERS
APN: 762-240-003-67 -300962- 17700 SW UPPER BOONES FERRY RD
Application description: WALL/FENCE SUITE 100
Property Zoning: MEDIUM DENSITY RES PORTLAND, OR 97224
Application valuation: 2402 Q
Conte r.
Applicant: Architect or Engineer: EED CONSTRUCTION INC
y 33 16 ONY ROAD, SUITE 105
CVgg E TAS, CA 92024
( = 634-2350
b'c. No. : 813480
-- --- ----- --- -- - ----- -------- -- ---------------------- ----- ----------------------- -—
LICE ED CONTRACTOR'S DEC TION WORKER'S COMPENSATION DECLARATION
I hereby a irm u der nalty of erjury t at I licensed under pro '' ns of Chapter 9(commencing with I hereby affirm under penalty of perjury one of the following declarations:
Sectio 00)o ision 3 of he Bus s d Professionals e,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
Licens� ass" icense No.:-813480 for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
issued.
ate: ntr -or: have and will maintain worke ' pensation insurance,as required by Section 3700 of the Labor
Code,for the performs a of the ark for which this permit is issued. My workers'compensation
OWNER-BUILDER DECLARATION insurance carrier an olicy num r are:
I hereby ffirm der penalty of perjury at I am exempt from the Contractor's State License Law for the Carrier S TE FUND olicy Number WC298892005
following reaso (Sec.7031.5,Business and Professions Code: Any city or county that requires a permit to I c ify that,in t pe ormance o the work for which this permit is issued,I shall not employ any
construct Iter, mprove,demolish,or repair any structure,prior to its issuance,also requires the applicant for the erson in a man so as t ecome subject to the workers'compensation laws of California,
permit to le a s ned statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree at,if ould b ome subject to the w kers'compensation provisions of Section
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 3 of he o s omply 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).: t'a: i
(_) I,as owner of the property,or my employees with wages as their sole compensation,will do the work,and .00
the structure is not intended or offered for sale(Sec.7044,Business and Professions Code: The WA NI : FAILURE TO RE 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 JEC AN EMPLOYER fR 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 LA S J$1 00,000). 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 S TI N 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
(_I 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.. ermit 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. arfi de,each person at hose request and for
pursuant to the Contractors'State License Law.). whose benefit work is performed under or purguant to any permit issue as a result of this application,
(_1 I am exempt under Sec. ,B.&P.C.for this reason the owner,and the applicant,each agree o,and shall defend,indem 'y and hold harmless the City
of La Quints,its officers,agents andni in
ployees for an t or omi n related to the work being
performed under or following issue a of this permi
Date: Owner: 2. Any permit issued as a r of is app
li
c
a
,
io a omes nu nd void if of commenced _
w'hin 0 days f date of ssuance of s ermi o work for 180 days will subject
CONSTRUCTION LENDING AGENCY mit ,ca tion. _
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify the ave ead his application and bove information is correct. I agree to comply with all
work for which this permit is issued(Sec.3097,Civ.C.I. city and co y or inan as and state laws relatin to ding construction,and hereby authorize representatives
_ of this to n r on the above-mentione rty for inspection purposes.
Lender's Name:
a , S' re(Applicant or Agen .
Lender's Address: '
LQPERMIT
Application Number . . 05-00004388
Permit . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 54.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 2402
Expiration Date 3/28/06
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
82 L.F. 6' & 13 L.F•. 2 ' & 22 L.F. 4'
BLOCK WALLS, ALL 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