05-5356 (BLCK) IIIIIII VIII III VIII IIII 33
IE
P.O. BOX 1504 `` 4VOICE(760)777-7012
C 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: 05-00005356 Owner:
Property Address: 80813 CALLE AZUL PUERTA AZUL PARTNERS
APN: 762-240-003-44 -30096 /� 17700 SW UPPER BOONES FERRY RD
Application description: WALL/FENCE /p\ a SUITE 10Q
Property Zoning: MEDIUM DENSITY RES D �n! PORTLAND, OR 97224
Application valuation: 795 DEC
22 2005 Contractor:
Applicant: Architect o En 17TNYY A DAVIS/REED CONSTRUCTION INC
FINANCE DEPT 169 SAXONY ROAD, SUITE 105
ENCINITAS, CA 92024
(760)634-2350
�} Lic. No. : 813480
0001,
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LI CONACTOR'S DECLAR WORKER'S COMPENSATION DECLARATION
I ereby affir nder p alty of p y t I licen' under provisio hapter 9(commencing with I hereby affirm under penalty of perjury one of the following declarations:
e tion 70 Di ' ion 3 of t us' ss nd Pr ssionals Code my Licen _ I have and will maintain a certificate of consent to self-insure for workers'compensation,as provided
f e B L' 80 — for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
issued.
ate: o act I have and wil imain workers' sation insurance,as required by tion 3700 of the Labor
he Performa the work for which this permit is issued. My kers'compensation
OWNER-BUILDER DECLARATION /inosderZaearrierpolicy number are:
Iy affirm un r penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier ST F Policy b WC 8892005
f Ilowing reason(Sec.7031.5,Business and Professions Code: Any city or county that requires a permit to I cenif that,' the pert ance of th r hi his permit is issued,I shall n employ any .
construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the pe on in a r so 'fornia,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State y e that,if I should be t e workers'comp6nsa' rovisions of Section
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or (/(/ 0 f the Labor Code,I sl o v' omply with thos isions.
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).: e: icant:
(_) 1,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 ARNI FAILURE TO SECU ORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL
Contractors'State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO 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 DOLLARS($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 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
(_) 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 ork 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,a the applican Teach agrees to,and shall defend,indemniff arm the City
of La Quin ,its officers, gents and employees for any act or on related lated to the work being
perform under or fol wing issuance of this p�
Date: Owner: 2. Any pe it issued a result of this aoe n b as null and v ' if w is not commenced
withi 180 days om date ance of s permit on rk for 180 days will subject
CONSTRUCTION LENDING AGENCY //�� p it to cance tion.
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certi rj, it read t '' p1'cation and stat at the a' ' correct. 1 agree to comply wit
work for-which this permit is issued(Sec.3097,Civ.C.). city d cou r ' n s tate laws rela g to bu' r io and hereby authorize re atives
of this cou po the above-mentio to rctio purposes.
Lender's Name:
Si ture(Applicant or '
Lender's Address: r�
LQPERMIT
Application Number . . . . . 05-000053,56
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 21.00 Plan Check Fee .00
Issue Date Valuation . . . 795
Expiration Date 6/06/06
Qty Unit Charge Per Extension
BASE FEE 15.00
3 .00 2.0000 HIND BLDG 501-2.,000 6.00
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Special Notes and Comments
19 L.F. 6- GARDEN, 20 L.F. 4' GARDEN &
8 L.F. 2 - GARDEN WALL, ALL ORCO SYSTEM
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 21.00 .00 .00 21.00
Plan Check Total .00 .00 .00 .00
Grand Total 21.00 .00 .00 21.00
LQPERMIT