05-5407 (BLCK) IIIIIIIIIIIIIIIIIIIIIIIII27 . uurtrcv
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: 12/12/05
Application Number: �5-00005407 r Owner:
Property Address: 80801 CALLE AZUL PUERTA AZUL PARTNERS
APN: 762-240-003-42 -30096 17700 SW UPPER BOONES FERRY RD
Application description: WALL/FENCE SUITE 100
Property Zoning: MEDIUM DENSITY RES D 2U05 PORTLAND, OR 97224
Application valuation: 1900 DEC 2 2
CE DOF�QUINTp► Contractor:
Applicant: Architect or E gineer:CITY EPT• DAVIS/REED CONSTRUCTION INC
FINAN 169 SAXONY ROAD, SUITE 105
ENCINITAS, CA 92024
(760)634-2350
( r ' LiC. No. : 813480
LICENSED CO CTOR' CLAR ION WORKER'S COMPENSATION DECLARATION
I hereby affir der penal of perjury that I am lic a br p - ions Chapter 9(commencing with I hereby affirm under penalty of perjury one of the following declarations:
S u in 70 1 of Division 3 o ss and P fe Is d ,an License is in full force and effect. _ I have and will maintain a certificate of consent to self-insure for workers'compensation,as provided
cense Cl ss: B ce a for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
issued.
ate: ontractor: I have and will maintain wort mpensatmn insurance, cared by Section 3700 of the Labor
Code,for the pert nce of the work for which this permit is i ed. My workers'compensation
OWNER-BUILDER DECLARATION insurance c r and policy number are:
1 reby affirm under penalty of perj y that I am exempt from the Contractor's State License Law for the Carrier STATE F Policy Number WC2986 2005
Ilowing reason(Sec.7031.5,Business and Professions Code: Any city or county that requires a permit to _ I certify t at ;n the performance o ork f which this permit is issu d,I shall not employ any
construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the person ny manner to becom o workers'co ensation 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 ree the t` orkers'co ensation provisions of Section
•License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 37 O 1 the abor Code, al p y
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).: at plicant:
( 1 I,as owner of the property,or my employees with wages as their sale compensation,will do the work,and
the structure is not intended or offered for sale(Sec.7044,Business and Professions Code: The W RNIN FAILURE TO SEC W ERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL
Contractors'State License Law does not apply to an'owner of property who builds or improves thereon, BJE 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 DOLLA S($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
(_) 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 e e as a result o t 'cation,
(_) I am exempt under Sec. ,B.&P.C.for this reason the owner,and the applicant,each agrees to,and s end,indemnify and hold harmless the
of La Quinta,its officers,agents and employ or any act or omission related to the work being
performed under or following issuance o is permit.
Date: Owner: 2. Any permit issued as.a result of this plication becomes null and void if work is not commenced
within 180 days from date of issu ce of such permit,or cessation of work for 180 days will subje
' CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and sta that the above informatio is correct. I agree to co with all
work for which this permit is issued(Sec.3097,Civ.C.). city and county ordinances and state laws relating building const I , hereby authori presentatives
of thi my to enter upon the bove-mentioned pro y for i on rpose ,
Lender's Name:
Date: ature(Applicant or Agent):
Lender's Address: '
LQPERMIT
A
• Application Number . . . . . 05-00005407
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee . . 43.00 Plan Check Fee 00
Issue Date Valuation . . 1900
Expiration Date 6/10/06
Qty Unit Charge Per Extension
BASE FEE 15.00
14.00 2.0000 HND BLDG 501-2,000 28.00
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Special Notes and Comments
76 L.F. 6' GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid Credited Due
----------------- ----------- ---------- ---------- ----------
Permit Fee Total 43.00 .00 .00 43.00
Plan Check Total .00 .00 .00 .00
Grand Total 43 .00 .00 .00 43.00
LQPERUff