05-5401 (BLCK) IIIIIIIIIIIIIIIIIIIIIIIII 18T-iht 4
P.O. BOX 1504 IE _, J ^' 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: 12112/05
Application Number: r- 05-00005401 ! b Owner:
Property Address: L- 80777 CALLE AZUL` O PUERTA AZUL PARTNERS
APN: 762-240-003-38 -300962- 17700 SW UPPER BOONES FERRY RD
Application description: WALL/FENCE FDIEC 2 2 2005 SUITE 100
Property Zoning: MEDIUM DENSITY RES PORTLAND, OR 97224
Application valuation: 1975
CITY OF LA QUINTA
FINANCE DEPT.
Contractor:
Applicant: Architect or Engineer: DAVIS/REED CONSTRUCTION INC
169 SAXONY ROAD, SUITE 105
ENCINITAS, CA 92024
(760)63
Lic. No.. :: 813 813480
--------- - ---- -- --- - -------- -- - ---- - ---------- ----------------------------------- ----- -------- -
ICENSED RACTOR'S DECLARATI WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of pe. ry that I am ' der provisions o apter 9(commencing with I hereby affirm under penalty of perjury one of the following declarations:
section 7000)of Division 3 0. Business a nals Code,ay License is in full force and effect. _ I have and will maintain a certificate of consent to self-insure for workers'compensation,as provided
Lic se Class: B Licein o.: 813480 for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
U� issued.
e: Cactor 1 have and will maintain workers'compensation insurance,as required by Section 3700 of the Labor
Code,for the performance of the work for which this permit is issued. My workers'compensation
OWNER-BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Pzii y_N mber WC298892005
following reason(Sec.7031.5,Business and Professions Code: Any city or county that requires a permit to - _ I certify that,in the pdrformance of the work for his perm' ued I shall not emp o any
construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the per in a0.0.yy manner so as to become a
the
c0m ation laws of Califor ia,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State .i��1 t r�tKat,if I should become le the a cc sation provisions of ion
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or of the Labor Code,I shal rt co it 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).: ���3700
iTHE
nt:
1_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 WARNING: FAISECU ERS'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 ETO NAL 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($10N ION 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 OR 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_) 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 pursue ' ued as a result of this application,
(_1 I am exempt under Sec. ,B.&P.C.for this reason the owner,and the applicant,eac o,and shall defend,indemni y a armless the City
of La Quinta,its officers is and employees for any act or omission related to the being
performed under owing issuance of this permit.
Date: Owner: 2. Any permit i d as a result of this application becomes null and void if work is not commenced
within 1 days from date of issuance of such permit,or cessation of work for 180 days will subje t
CONSTRUCTION LENDING AGENCY perm' o cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I he a read this application and state th the abo motion i rect. I agree to com ith all
work for which this permit is issued(Sec.3097,Civ.C.) city and co my o 'nances and ate laws re g to bui rdccti nd hereby authorize esentatives
of thi ounty t0 ante above- ntioned sp n purposes.
Lender's Name: /
ate: ignat (Applica ge
Lender's Address:
LQPERMIT
Application Number . . . . . 05-00005401
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 45.00 Plan Check Fee .00
Issue Date Valuation 1975
Expiration Date 6/10/06
Qty Unit Charge Per Extension
BASE FEE 15:00
15.00 2.0000 HIND BLDG 501-2,000 30.00
---------------------------------- ------------------------------------------
Special Notes and Comments
79 L.F. 6' GARDEN WALL ORCO SYSTEM
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Fee Total 45.00 .00 .00 45.00
Plan Check Total .00 .00 00 _ :00 -
Grand Total - 45.00 .00 .00 45.00
• J
LQPERMIT