05-4376 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
I hereby Pffirl under pe y of
Section 00 of Di on 3 of t
05-00004376
80805 VIA PUERTA
762-240-003-74
WALL/FENCE
MEDIUM DENSITY R:
2634
c&ht 4 XA Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
AZUL
-3009,
3480
r 9 (commencing with
is in full force and effect.
�/ /�}NNER-BUILDER DECLARATION
I her by 14ffirm under penalty of at I a exempt from the Contractor's State License Law for the
followin�/reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
constru,YS 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 li6ensed 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 1$5001.:
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 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 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 ISec. 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
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
Jissued.
I have and will maintain workers' compensation insuran gt�ired by Section 3700 of the Labor
Code, for the performance of the work for w ' is permit is sued. My workers' compensation
insurance carrier and policy number are,
Carrier STATE FUND Po' Number WC29 92005
_ I c rtify at, in the performan he rk for which permit is issued, I shall not employ any
per n in any manner so bet a subject to a workers' compensation laws of California,
/an agr f I sho co ubjact t e workers' compensation provisions of Section
ILURE TO SECUFYWORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Q EMPLOYER TOCRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
06 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 ' ' as a result of this application,
the owner, and the applicant, each agrees to, an defend, indemnify a hold harmless the City
of La Ouinta, its officers, agents and emplo for any act or omission related to the work being
performed under or following issuance is permn.
2. Any ermit issued as a result of this plication be null d void if work is not commenced
Awitl�n 180 da date of is ante of such q 0 ssation of work foJr160 days will subject
he:
v ad this application a d state that the i rmation is corre I agree to comply with all
an dinances and state law lating to bui ,
nter upon th bove-mentione prop r ' spection oses.
. nature (Applicant or Agent)•
Application Number . . . . . 05-00004376
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 54.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 2634
Expiration Date 3/28/06
Qty Unit Charge Per
Extension
BASE
FEE
45.00
1.00 9.0000 THOU BLDG
2,001-25,000
9.00
----------------------------------------------------------------------------
Special Notes and Comments
90 L.F. 6' & 13 L.F. 2' & 24 L.F.
4'
BLOCK WALLS, ALL ORCO SYSTEM
Fee summary Charged
Paid
Credited
Due
-------------------------------------
Permit Fee Total 54.00
----------
.00
----------
.00
54.00
Plan Check Total .00
.00
.00
.00
Grand Total • 54.00
.00
.00
54.00
LQPERMIT