05-4382 (BLCK)-.,
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 057,00004382
Property Address: 80758 VIA PUERTA AZUL
APN: 762-240-003'-22 -300962-
Application description: WALL/FENCE
Property Zoning: MEDIUM DENSITY RES
Application valuation: 1225
Applicant:
I hereby
Section
License
te:
I W OWNER -BUILDER DECLARATION
I hereby i and r penalty of perjury t I am exempt from the Contractor's State License Law for the
following rea n ( c. 7031 .5, Busines and Professions Code: Any city or county that requires a permit to
construct, alte , 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 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 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
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 imploves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
T-v4t 4 4 Q"
Architect or Engineer:
1 )Ip,
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/29/05
-----+--------------------------------------------------------- - - - - -- - - - - - —
LICENSED CO TRACTOR' CLARATION
un r penalty of per' ry that I am licen d unde _visions of Chapter.9 (commencing with
of vision 3 of the usi and Prof sio Code, and my License is in full force and effect.
License No.: 813480
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:
Lender's Address:
LQPERMIT
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' compensation insurance, as req ' by Section 3700 of the Labor
T' Code, for the performance of the work for which this pe is issued. My workers' compensation
rance carr' rand p ct y nJ bar are:
CarrieTTJ
UN Policy Nu WC2988920.05
y at, in the pe or ance f the for which this permit is issued, I shall not employ any
on in any man er as t me subject to the workers' compensation laws of California,
agree that, if I I ome subject to the workers' compensation provisions of Section
0 of the Labor , I hall forthwith comply with those provisions.
JINt�FAILURE TO SECU f WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
ECT N EMPLOYER TO CFIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
ARSI$100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
ION 706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMP RTANT 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 agrees to, and sh end, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees r any act r omission related to the work being
performed under or following issuance of thi ermit.
2. Any permit issued as a sult of this appli ion becomes and void if work is not commenced
within 1,130 days ate of issuanc f such permitssation of work -for -180 days will subject
I certify that I ffiveead/15is application and sta that ov mation is correct. I agree to comply with all
city and c u y or finances and state laws rel ing to nstruction, and hereby authorize representatives
of th' oun t me pon t ove-ment' ned pr !,o nspection purposes.
Date: nature (Applicant gent),
Owner:
PUERTA AZUL PARTNERS
/ d
17700 SW UPPER BOONES FERRY RD
SUITE 100
ORTLAND, OR 97224
cof r �ZOQS
Contractor:
{ OF44
►CFC��/lyrq
DAVIS/REED CONSTRUCTION INC
169 SAXONY ROAD, SUITE 105
ENCINITAS, CA 92024
(760)634-2350
i
Lic. No.: 813480
Date: 9/29/05
-----+--------------------------------------------------------- - - - - -- - - - - - —
LICENSED CO TRACTOR' CLARATION
un r penalty of per' ry that I am licen d unde _visions of Chapter.9 (commencing with
of vision 3 of the usi and Prof sio Code, and my License is in full force and effect.
License No.: 813480
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:
Lender's Address:
LQPERMIT
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' compensation insurance, as req ' by Section 3700 of the Labor
T' Code, for the performance of the work for which this pe is issued. My workers' compensation
rance carr' rand p ct y nJ bar are:
CarrieTTJ
UN Policy Nu WC2988920.05
y at, in the pe or ance f the for which this permit is issued, I shall not employ any
on in any man er as t me subject to the workers' compensation laws of California,
agree that, if I I ome subject to the workers' compensation provisions of Section
0 of the Labor , I hall forthwith comply with those provisions.
JINt�FAILURE TO SECU f WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
ECT N EMPLOYER TO CFIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
ARSI$100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
ION 706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMP RTANT 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 agrees to, and sh end, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees r any act r omission related to the work being
performed under or following issuance of thi ermit.
2. Any permit issued as a sult of this appli ion becomes and void if work is not commenced
within 1,130 days ate of issuanc f such permitssation of work -for -180 days will subject
I certify that I ffiveead/15is application and sta that ov mation is correct. I agree to comply with all
city and c u y or finances and state laws rel ing to nstruction, and hereby authorize representatives
of th' oun t me pon t ove-ment' ned pr !,o nspection purposes.
Date: nature (Applicant gent),
Application Number . . . . . 05-00004382
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . 29.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 1150
Expiration Date . . 3/28/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
7.00 2.0000 HND BLDG 501-2,000
14.00 .
----------------------------------------------------------------------------
S ecial Notes and Comments
4�) L.F. 6' BLOCK WALL, ORCO SYSTEM
Fee summary Charged Paid
---------------------------
Credited
Due
----------
Permit Fee Total 29.00
----------
.00
----------
.00
29.00
Plan Check Total .00
.00
.00.
.00
Grand Total 29.00
.00
.00
29.00
LQPExMrr