05-5400 (BLCK) f 11111111 VIII III VIII IIII 15 .
t IE Qawim
P.O. BOX 1504 ---T 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: 05-00005400 Owner:
Property Address: 80771 CALLS AZUL PUERTA AZUL PARTNERS
APN: 762-240-003-37 -3009 Q 17700 SW UPPER BOONES FERRY RD
Application description: WALL/FENCE SUITE 100
Property Zoning: MEDIUM DENSITY RES 1 DEC 2 2 2005 PORTLAND, OR 97224
Application valuation: 953
CITYOF LAQUINTA Contractor:
Applicant: Architect o Engine
fiNANCEDEPT. DAVIS/REED CONSTRUCTION INC '
169 SAXONY ROAD, SUITE 105.
ENCINITAS, CA 92024
f� (760)634-2350
Lic. No. : 813480
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing wy 1 hereby affirm under penalty of perjury one of the following declarations:
section 7000)of Division 3 of the Bu ' ss and Professionals Code,and my License is in full force and ect. _ I have and will maintain a certificate of consent to self-insure for workers'compensation,as provided
License Class: B License No.: 813480 for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
Aj ..,., issued.
-IIafe:�— ntractor: . I have and will maintain workers'cD ensation insurance,as required by Se 'on 3700 of the Labor
Code,for the performance the work for which this permit is issued. My orkers'compensation
OWNER-BUILDER DECLARATION insurance carrier and icy 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 Policy bar 8892005
following reason(Sec.7031.5,Business and Professions Code: Any city or county that requires a permit to _ I certify that,in performance oft for his permit is issued shall not employ any
construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the person in asaner so as to cc sub' the work s'-comp ation 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 agre that,if,I should b om ubj a work comp ation provisions of Section
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or Z�JO5of e Labor Code, she ort/i omply o rovisions.
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).: ;OADate: pplicant:
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: FAILURE TO SEC ORK S'COMPENSATION COVERAGE IS UNLAWFU HALL
Contractors'State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER IMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOU
and who does the work himself or herself through his or her own employees,provided that the DOLLARS($100,000). 1 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 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 toawns a result of this application,
(_1 I am exempt under Sec. ,B.&P.C.for this reason the owner,and the applicant,each agrees to,adf211 efend,indemnify an M-ha(Lnless the City
of La Quinta,its officers,agents and em ees for any act or omission related to the work being
performed under or following issu of this permit.
Date: Owner: 2. Any permit issued as a result is application becomes null and void if work is not commenced
within 180 days from da of issuance of such permit,or cessation of work for 180 days will subject
CONSTRUCTION LENDING AGENCY permit to c ation.
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the 1 certify that I have ad this app' ation and state that th ov f tion i rrect. I agree t orSiply with all
work for which this permit is issued ISec.3097,Civ.C.1. city ccu o finances and state laws relating to di ucti yy�� d hereby-au a representatives
o thi ntlp�ter upon th bove-mentioned pe spe t' purposes.
Lender's Name:
ate: gnature(Applicant or e
Lender's Address:
LQPERMIT
Application Number . . . . . 05-00005400
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 25.00 Plan Check Fee .00
Issue Date . . . Valuation 953
Expiration Date 6/10/06
Qty Unit Charge Per Extension
BASE FEE 15.00
5.00 2 .0000 HND BLDG 501-2, 000 10.00
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Special Notes and Comments
44 L.F. 5- GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 25.00 .00 .00 25.00
Plan Check Total .00 .00 .00 .00
Grand Total 25.00 .00 .00 25.00
LQPERMIT