05-4379 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00004379
Property Address: 80782 VIA PUERTA AZUL
APN: 762-240-003-18 -300962-
Application description: WALL/FENCE
Property Zoning: MEDIUM DENSITY RES
Application valuation: 1898
Applicant:
V
Tityl 4 4 Q"
Architect or Engineer:
P 1A
— — — — — — — r — — — — — — — — _p _ _ + — — — — — — — — — — — — —
BUILDING & SAFETY DEPARTMENT
BUlUMG PERMIT
E ED NTRACTOR'S DECLARAT
tty of perjury t t I ice sed under provisions apter 9 (commencing with
3 of th Busi ss ro ssionals Code, my License is in full force and effect.
Lic No.: 813480
�' - V' OWNER -BUILDER DECLARATION
I he by ffirm under penalty of perjury t at I am exempt from the Contractor's State License Law for the
folI win reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
co truiiiiiiAAddddt, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
per it to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
Lic 6e Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
t 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 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.).
(_) 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
4\ Owner:
PUERTA AZUL PARTNERS
7700 SW UPPER BOONES FERRY RD
ITE 100
7 PO LAND, OR 97224
ontractor:
AVIS/REED CONSTRUCTION INC
169 SAXONY ROAD, SUITE 105
ENCINITAS, CA 92024
(760)634-2350
Lic. No.: 813480
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
1 issued.
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 policy num
Carrier ST TES FUND Policy Number WC298892005
I c rtify tha , n the Performa a of the ork for which this permit is issued, I shall not employ any
person in any manner so s t ec a subject to the wo n aws of California,
and agree that, if I ho d b subject or ers' compensation provisions of Section
_00 of the LCod t comply with those provisions.
WAf NINq: FAILURE TO SECURE WCPqKERS' 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.
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 a permit issued as a result of this application,
the owner, and the applicant, each agrees to, and sh I defe , indemnify and hold harmless the City
of La Quinta, its officers, agents and employees or any act o omission related to the work being
performed under or following issuance of �this permit.
2. Any permit issued as a result of this appication becomes nu and void if work is not commenced
within 180 days from date of issuagee of such permit, or essation of work for 180 days will subject
I certify that 1 h e ea is application and tate that thation is correct. I agree to comply with all
city and c nt r n nces and law elating t ruction, and hereby authorize representatives
of this o e Jer upon above -m propA!rspec.tim.'in purposes.
(Applicant or Agent):
r
Application Number . . . . . 05-00004379
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 43.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 1898
Expiration Date 3/28/06
Qty Unit Charge Per
Extension
BASE
FEE
15.00
14.00 2.0000 HIND BLDG
501-2,000
28.00
--------------------------------------------------------
Special.Notes and Comments
--------------------
58 L.F. 6' & 65 L.F. 2' & 28 L.F.
4'
BLOCK WALLS, ALL ORCO SYSTEM
Fee summary Charged
Paid Credited
Due
-------------------------------------
Permit Fee Total 43.00
----------
.00
----------
.00
43.00
Plan Check Total :00
.00
.00
.00
Grand Total 43.00
.00
.00
43.0.0
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