05-3384 (BLCK)P.Q. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00003384
Property Address: 80800 VIA PUERTA AZUL
APN: 762-240-003-15 -300962-
Application description: WALL/FENCE
Property Zoning: MEDIUM DENSITY RES
Application valuation: 1325
Applicant:
I hereby #fiirm/rnder alty of
Section 000) f vision 3 of t
T4'vl 4�
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
f
BUILDING PERMIT
DDate: 8/03/05
Owner:
PUERTA AZUL PARTNERS
A 17700 SW UPPER BOONES FERRY RD
AiIG 3 02��5 SUITE 100
PORTLAND, OR 97224
CITY OF LAe GUINTq
FlNeun
effect.
// NER.BUILDER'DECLARATION
I her y aF((irm under penalty of perjury that I exempt from the Contractor's State License Law for the
follo mg eason (Sec. 7031.5, Business and Pro ass
Code: Any city or county that requires a permit to
construct, alter, 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).:
(_) 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.).
(_) 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—) I am exempt under Sec. , BAP.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:
LQPERI%IIT .
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 Cod the performance of the work for which this permit is
issued.
have and will maim ' orkers' compensation insurance, as required by Section 3700 of the Labor
T Code, for th ormance of the work for which this permit is issued. My workers' compensation
insuranc rner and policy number are:
Carrier STATE F D PoicyN er WC298892 OS
_ I certif that, in the erfor ce of a for which this perm' is issued, I shall not employ any
perso anner Iifornia,
and ag that, if I d b o subject to the work compensation provisions of Section
�f the Lab orthwith comp) those provisions.
App' a
WARNING: FAILURE TO CURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYE 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 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 any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes aid if work is not commence
within 180 days from date of issuance of su it, or cessation of work f will subject
permit to cance lation.
certify that I ha read t application and stat that the above infor i orrect. I agree to mply with all
city and count ordina s aytl�'sate laws relating uildin c n ereby authoti representatives
of this nt o ent uporrthe above-mentioned prope or i ec ' poses.
ature (Applicant or Age /
Contractor:
Architect or Engineer:
DAVIS/REED CONSTRUCTION INC
169 SAXONY ROAD, SUITE 105
ENCINITAS, CA 92024
(760)634-2350
LiC. No..::813813480
�r
�-------- -----------------------------------------------------------
effect.
// NER.BUILDER'DECLARATION
I her y aF((irm under penalty of perjury that I exempt from the Contractor's State License Law for the
follo mg eason (Sec. 7031.5, Business and Pro ass
Code: Any city or county that requires a permit to
construct, alter, 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).:
(_) 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.).
(_) 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—) I am exempt under Sec. , BAP.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:
LQPERI%IIT .
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 Cod the performance of the work for which this permit is
issued.
have and will maim ' orkers' compensation insurance, as required by Section 3700 of the Labor
T Code, for th ormance of the work for which this permit is issued. My workers' compensation
insuranc rner and policy number are:
Carrier STATE F D PoicyN er WC298892 OS
_ I certif that, in the erfor ce of a for which this perm' is issued, I shall not employ any
perso anner Iifornia,
and ag that, if I d b o subject to the work compensation provisions of Section
�f the Lab orthwith comp) those provisions.
App' a
WARNING: FAILURE TO CURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYE 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 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 any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes aid if work is not commence
within 180 days from date of issuance of su it, or cessation of work f will subject
permit to cance lation.
certify that I ha read t application and stat that the above infor i orrect. I agree to mply with all
city and count ordina s aytl�'sate laws relating uildin c n ereby authoti representatives
of this nt o ent uporrthe above-mentioned prope or i ec ' poses.
ature (Applicant or Age /
-f.
•
LQPERMIT
Application Number . . . . . 05-00003384
Permit . . . . .
. WALL/FENCE PERMIT
Additional desc .
Permit Fee . . .
. 33.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 1325
Expiration Date
1/30/06
Qty.. Unit Charge Per
Extension
BASE.FEE
15.00
9.00 2.0000 HND BLDG 501-2,000
18.00
----------------------------------------------------------------------------
Special Notes and
Comments
53 L.F. 6' GARDEN
WALL, ORCO SYSTEM
Fee summary
-----------------
Charged Paid Credited
------------------------------
----------
Due
Permit Fee Total
33.00
.00
.00
33.00
Plan Check Total
.00
.00
.00
.00
Grand Total
33.00
.00
.00
33.00