BLCK (04-4707)57325 Madison St Lot A
04-4707
S
BUILDING & SAFETY DEPARTMENT
4 P.O. Box 1504
(760).777-7012
78-495 CA
OF.TI LLE TAMPICO FAX (760),777-7011
LA QuINTn, CALIFORNIA 92253
INSPECT ION- REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . (04-000_04~707 Date 6/02/04
Property Address 57325 MADISON.ST LOT A
APN: 762-240-003-A 300961- -
Application.description . . . WALL/FENCE
Property Zoning. . . . . ..• MEDIUM DENSITY RES
Application valuation. 30900
Owner Contractor
PUERTA AZUL PARTNERS DAVIS/REED. CONSTRUCTION INC
•,17700 SW UPPER BOONES FERRY RD 169 SAXONY ROAD, STE.#105
SUITE 100 ENCINITAS CA 92024
PORTLAND OR 97224 (760) 634-2350
WCC: STATE FUND
WC: WC298892003 06/12/04
CSLB: 813480 10/31/04
CCC: B
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Permit WALL/FENCE PERMIT
Additional desc
Permit'Fee 291.00 Plan Check Fee .00
Issue Date . . . . Valuation . . 3.0900
Qty. Unit Charge Per Extension
BASE. FEE x 252.00
6.00 6.5000,:THOU 'BLDG :25;'001-50,000 39.00
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Special Notes and Comments
1236 LF COMBO 2' RETAINING WITH 6' n
GARDEN WALL PER ORCO DETAIL & APPROVED'
PRECISE GRADING PLAN IRov c q C,;/jai,
Fee summary Charged Paid Credited Due
Permit Fee Total 291.00 .00 .00 291.00
Plan Check Total .00 .00 .'00 .00
Grand Total 291.00 .00 00. 291.00 '
-JUN 0 32004
c uINTA
Fi6dA+N9CE DI=PT.
P.O. BOX I SOA - - • 'G` •
78-495 CALLE TAMPICO w
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number: 0-1_ 1-70
Applicant -
Applicant's
MailingAddress:
VOICE. (760) 777-701;
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: u/o 2la'¢
Architect or En . eer:
fV
Architect or ngineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I odeh6rebya affirm under penalty of perjury that I am licensed under provisions of C pteer mmencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my Licen is in full force and effect. 1
License Cllass . kcense N . "
Date (Si Z 0 Contractor
1 hereby affirm under penaltyof OWNER -BUILDER DECLARATION
perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031 .5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or 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).):
U 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 Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is
sold within 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. ).
U 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
_ I 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. f y workers' compensation insurance Cartier and policy number are: r
Cartier STATE rdi✓ ] 2 -
_ l certify that in the performance of the worKfor which this r '+ ' w-v
pe It its k sued, I'shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Califo ,and agree that, if I s j to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with tho provisions
Date 'Z <
. . -Z Al /_1
WARNING: FAILURE TO SECURE WO KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I herebyaffirm under y p 0 CONSTRUCTION LENDING AGENCY
penalty of peq* that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
IMPORTANT APPLICANT ACKNOWLEDGEMENT
Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any pertmit
issued as a result of this application, the owner, and the applicant, each agrees to. and shall, defend, indemnity and hold harmless the City of La Qui►da, its
officers, agents and employees for any act or omission related to the.-work-b;ding performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes nul d void if work is not common within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to ca ation.
I certify that I have read this application and state that the abov nformation is 18
construction, and hereby authorize representatives of this c my to enter a all ' and county ordinances and state laws relating to building
rope nspetition purposes.
Date }(% Signature (Applicant or Agent):