05-4380 (BLCK)P.O OX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: " 05-00004380
Property Address: 80776 VIA PUERTA AZUL
APN: 762-240-003-19 -300962
Application description: WALL/FENCE
Property Zoning: MEDIUM DENSITY RES
Application valuation: 375
Applicant: Architect or
Tit�v440"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------- �..soe
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U NSED ONTRACTOR'S DECLARN
I hereby v under natty of perjuis
tha I licensed under provisions of C9 (commencing with
Section 0 of vision 3 of the Bes Prof ssionals Code, and m is in full force and effect.
License Llas B License No 13480
/1�/ 0 ER -BUILDER DECLARATION
I hereb a iI'm under penalty of pert that exempt from the Contractor's State License Law for the
followi reson (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
constru t, aer, 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 _ 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 I, 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.).
1 _ 1 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/29/05"
Owner:
PUERTA AZUL PARTNERS
17700 SW UPPER BOONES FERRY RD
SUITE 100
PORTLAND, OR 97224
Contractor:
DAVIS/REED CONSTRUCTION INC
169 SAXONY ROAD, SUITE 105
ENCINITAS, CA 92024
(760)634-2350
Lic. No.: 813480
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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 required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and Dolicv nurAt-er 3�.e:
Carrier STATg FUND PolicyjNumber WC298892005
_ I rti that, in th r orma/t�.e
he Jork for which this permit is issued, I. shall not employ any
pe son in manners co a subject to the workers' compensation laws of California,
a d agsee that, if I sho d bject to the workers' com ation provisions of Section
00•of the Labor Co e, Io with comply provisions.
AILUAE TO SECURE WO�,XERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
EMPLOYER TO CRIMIN 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 La Quinta, its officers, agents and employees for an act or omission related to the work being
p ormed under or following issuance of this pe
ny permit issued as a result of this applicati ecomes n II and void if work is not commenced
ithin 180 days from date of issuance of ch permit, or cessation of work for 180 days will subject
permit to cancel) ion.
4ce2th I have rea s application and state t t a ove i ormation is S,gue I agree to comply with all
my ord ances and state laws relatin o i g con o i g co truai hereby authorize represeauthorize representatives
my to enter upon the ove-mentione pro e f son purposes.
Si ture (Applicant or Ag
r
Application Number . . . . 05-00004380
Permit . .
. WALL/FENCE PERMIT
Additional desc .
Permit Fee . . .
. 15.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 375
Expiration Date .
. 3/28/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
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Special Notes and
Comments
15 L.F. 6' & 8 L.F. 2' BLOCK WALLS,
BOTH ORCO SYSTEM
Fee summary
-----------------
Charged Paid
Credited
Due
Permit Fee Total
--------------------
15.00
----------
.00
----------
.00
15.00
Plan Check Total
.00
.00
.00
.00
Grand Total
15.00
.00
.00
15.00
LQPERMIT