05-4383 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00004383
Property Address: 80764 VIA PUERTA AZUL
APN: 762-240-003-21 -300962-
Application description: WALL/FENCE
Property Zoning: MEDIUM DENSITY RES
Application valuation: 1150
Applicant:
I here a rm u er penalty of
Sectio 70 0) o Division 3 of tl
Tji�v 4 4 Q"
Architect or Engineer:
01A
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
PUERTA AZUL PARTNERS
17700 SW UPPER BOONES FERRY RD
SUITE 100
d PORTLAND, OR 97224
ontractor.
17�00� AVIS/REED CONSTRUCTION INC
169 SAXONY ROAD, SUITE 105
ENCINITAS, CA 92024
(760) 634-2350
Lic. No.: 813480
— — — — — —
TOR'S DECLARATION
rider provisions of Chapter 9 (commencing with
Is Code, and my License is in full force and effect.
license No.: 813480
VX, AJ OWNER -BUILDER DECLARATION
I hereby ffirunder penalty of perjury that I am exempt from the Contractor's State License Law for the
following eas (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, Iter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to f e 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 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 contractors) licensed
pursuant to the Contractors' State License Law.).
I—) 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:
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.
1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance o. the work for which this permit is issued. My workers' compensation
insurance carrier and p cy n ber are:
Carrier ST TE F Policy Number 98892005
I certif hat, in the. rforman a of the w �r which this permit is issued, I shall not employ any
141erson in any Soo
to b e subject to the workers' compensation laws of California,
and agree that I ould me subject to the workers' compensation provisions of Section
�w 3700 of the L r shall forthwith comply with those provisions.
is FAILURE TO SECUAIE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
($100,000). IN ADDITION 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 agrees to, and shall defend, indemnify and hold harmless the City
of Quints, its office -and employees for any act or omission related to the work being
pe ormad un r following ' ' uan of this permit.
An perm' sued as a rbsu of this ap `cation becomes null and void if work is not commenced
wi, in 0 days from da of issuaPce of such permit, or cessa ' or foi 180 days will subject
of
cancellation.
id this aoolicat nand
(Applicant
information is correct. I agree to comply with all
ig construction, and hereby authorize representatives
for inspection purposes.
Application Number . . . . 05-00004383
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 HIND BLDG 501-2,000
14.00
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Special Notes and Comments
46 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
LQPERMIT