05-4384 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00004384
Property Address: 80752 VIA PUERTA AZUL
APN: 762-240-003-23 -300962-
Application description: WALL/FENCE
Property Zoning: MEDIUM DENSITY RES
Application valuation: 1448
Applicant:
Titit 4 4 Q"
Architect or Engineer:
�A
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
-- ------------------------------------------------------- - - - - - -
I hereby a it and r penalty perjury
Section 00 of ivision 3 f the Busi
P CONTRACTOR'S DECLARATION
i licensed under provisions of Chapter 9 (commencing with
Professionals Code, and my License is in full force and effect.
License No.: 813480
I if- OWNER -BUILDER DECLARATION
I hereby affi \hu der penalty of perl r that I am exempt from the Contractor's State License Law for the
following rea o Sec. 7031.5, Busi sand Professions Code: Any city or county that requires a permit to
construct, alt , i prove, demolish, repair any structure, prior to its issuance, also requires the applicant for the
permit to file a i ned statement that a or she is licensed pursuant to the provisions of the Contractor's 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).:
(_ 1 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 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.).
(_) 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.).
(_) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury 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: ,,ll
Lender's Address:
LQPERMIT
Date: 9/29/05
WORKER'S 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' c pananon insurance, as required by Section 3700 of the Labor
Code, for the performance of a wfor which this permit is issued. My workers' compensation
Asurance carrier and oolicv umber
Carrier STAT11 FUN Pol' y Number WC298892_0.05'
I c rtify at, in the perfoid
work for which t ' it is issued, I shall not employ any
per n in any mannerme subje a workers' compensation laws of California,
an agreethat, if I s o theworkers' compensation provisions of Section
00 of the L ohwith comply with those provisions.
FAILURE TO SECURE OKKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
N EMPLOYER TO CRI NAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
($100,000). IN ADDIT ON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT 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 permit issued as a result of this application,
the owner, and the applicant, each a o, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents d emplo ees for any act or omission related to the work being
performed under or followin ' suance of t s permit.
2. ny per it issued as a res of this applic ion becomes null and void if work is not commenced
ithin 180 days from a of issuance o such permit, or cessation of work for 180 days will subject
' to cancellationI certify
�1,�erm
ha read this app' ation to hat the above information is correct. I agree to comply with all
city andy rdinances and tate I ing to building constru ion, and hereby authorize representatives
of this t enWr upon t ov - coned propert spection purposes.
Owner:
d
PUERTA AZUL PARTNERS
17700 SW UPPER BOONES FERRY RD
SUITE 100
/anp
ORTLAND, OR 97224
row -1 ��Ops
Contractor:
DAVIS/REED CONSTRUCTION INC
169 SAXONY ROAD, SUITE 105
ENCINITAS, CA 92024
(760)634-2350
Lic. No.: 813480
-- ------------------------------------------------------- - - - - - -
I hereby a it and r penalty perjury
Section 00 of ivision 3 f the Busi
P CONTRACTOR'S DECLARATION
i licensed under provisions of Chapter 9 (commencing with
Professionals Code, and my License is in full force and effect.
License No.: 813480
I if- OWNER -BUILDER DECLARATION
I hereby affi \hu der penalty of perl r that I am exempt from the Contractor's State License Law for the
following rea o Sec. 7031.5, Busi sand Professions Code: Any city or county that requires a permit to
construct, alt , i prove, demolish, repair any structure, prior to its issuance, also requires the applicant for the
permit to file a i ned statement that a or she is licensed pursuant to the provisions of the Contractor's 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).:
(_ 1 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 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.).
(_) 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.).
(_) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury 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: ,,ll
Lender's Address:
LQPERMIT
Date: 9/29/05
WORKER'S 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' c pananon insurance, as required by Section 3700 of the Labor
Code, for the performance of a wfor which this permit is issued. My workers' compensation
Asurance carrier and oolicv umber
Carrier STAT11 FUN Pol' y Number WC298892_0.05'
I c rtify at, in the perfoid
work for which t ' it is issued, I shall not employ any
per n in any mannerme subje a workers' compensation laws of California,
an agreethat, if I s o theworkers' compensation provisions of Section
00 of the L ohwith comply with those provisions.
FAILURE TO SECURE OKKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
N EMPLOYER TO CRI NAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
($100,000). IN ADDIT ON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT 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 permit issued as a result of this application,
the owner, and the applicant, each a o, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents d emplo ees for any act or omission related to the work being
performed under or followin ' suance of t s permit.
2. ny per it issued as a res of this applic ion becomes null and void if work is not commenced
ithin 180 days from a of issuance o such permit, or cessation of work for 180 days will subject
' to cancellationI certify
�1,�erm
ha read this app' ation to hat the above information is correct. I agree to comply with all
city andy rdinances and tate I ing to building constru ion, and hereby authorize representatives
of this t enWr upon t ov - coned propert spection purposes.
Application Number . . . . . 05-00004384
Permit . . . WALL/FENCE
PERMIT
Additional desc . .
Permit Fee . . . . 35.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
1448
Expiration Date 3/28/06
Qty Unit Charge Per
Extension
BASE
FEE
15.00
10.00 2.0000 HND BLDG
501-2,000
20.00
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Special Notes and Comments
40 L.F. 6' & 28 L.F. 4' BLOCK WALLS,
BOTH ORCO SYSTEM
Fee summary Charged
Paid
Credited
Due
-------------------------------------
Permit Fee Total 35.00
----------
.00
----------
.00
35.00
Plan Check Total .00
.00
.00
.00
Grand Total 35.00
.00
.00
35.00
LQPERMIT