05-5357 (BLCK) =+ I IIIIIII VIII III I IIII 381 4'
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: 0-5-00005357 \ Owner:
Property Address: 808-19--CALLE AZUL n PUERTA AZUL PARTNERS
APN: 762-240-003-45 -30096 D W 17700 SW UPPER BOONES FERRY RD
Application description: WALL/FENCE SUITE 100
Property Zoning: MEDIUM DENSITY RES DEC 2 2 2005 PORTLAND, OR 97224
Application valuation: 1050
CITY OF L A UINTA Contractor:
Applicant: Architect or n ' .FINANCEDEPT. DAVIS/REED CONSTRUCTION INC
169 SAXONY ROAD, SUITE 105
ENCINITAS, CA 92024
(760)634-2350
Lic. No. : 813480
LICENSED CONT S LARATION WORKER'S COMPENSATION DECLARATION
I hereby affir under nalty f perjury that I am licens r sions of Chapter 9 Ico mencing with 1 hereby affirm under.penalty of perjury one of the following declarations:
Section 70 1 of Di sion o the Business and Prof C e,and my Licen mi force and effect. _ I have and will maintain a certificate of consent to self-insure for workers'compensation,as provided
License CI s: B nse No.: 8 80 - for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
—" issued.
D e Contra _ I have and will maintain workers'compensa' nsurance,as required by Section 00 of the Labor
Code,for the performance of the for which this permit is issued. My worker'compensation
WNER-BUILDER DECLARATION insurance:carrier and policy n er are:
I he by aff'm under penalty of perjury t I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Nu b r C298 2005 .
fol wing ason(Sec.7031.5,Business and Professions Code: Any city or county that requires a permit to _ I certi that,i he perfo ance of the w r hich thi rmit is issued,I shall no employ any
c stru ,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the rson in y man so as to beco ct to orkers'compensation s of California,
rmit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agr tha ' ould becom to t orkers'compensat' ovisions of Section
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 3700 a Labor Co e, I with those ions.
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 15500).: Date 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 ISec.7044,Business and Professions Code: The W R G: AILURE TO SECURE W S'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL
Contractors'State License Law does not apply to an owner of property who builds or improves thereon, S B CT N EMPLOYER TO CR" L 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 LA ($100,000). IN ADDITI N 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 CTI 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
(_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,
I—) I am exempt under Sec. B.&P.C.for this reason the owner,and the applicant,each agrees to,and shall defend,inde!MmDAV_aadhoW-hacraW§s the City
of La Quinta,its officers,agents and employees for any mission related to the work being
performed under or following issuance of this pe
Date: Owner: 2. Any permit issued as a result of this applic becomes null and void if work is not commenced
a in 180 ays from date of issuanc f such permit,or cess tion for 1 days will su ' t
CONSTRUCTION LENDING AGENCY permit to ancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify at I have ad this application and state that t agree t omply with all
work for which this permit is issued(Sec.3097,Civ.C.). Gf n county ar finances ate laws relating to building con u d y aut a rep
f i unty t mer u on the above-mentioned property for' s pu es.
Lender's Name:
D e: Signature(Applicant or Agent):
Lender's Address: '
LQPERMIT
Application Number . . . . . 05-00005357
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee 2.7..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 HND BLDG. 501-2,000 12 .00
----------------------------------------------------------------------------
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
LQPERMTT -