05-3383 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: .
05-00003383
Property Address:
80806 VIA PUERTA AZUL
APN:
762-240-003-14 -300962-
Application description:
WALL/FENCE
Property Zoning:
MEDIUM DENSITY RES
Application valuation:
916
Applicant: Architect or Engineer:
I hereby afiirr]rtntr penalty of perjury that I
Section 7000 o rvisthe Busies
1.3
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
.Date: 8/03/05
CITY OF LAOUINTA Uwner:
FINANCE DEPT- PUERTA AZUL PARTNERS
17700 SW UPPER BOONES FERRY RD
SUITE 100
PORTLAND, OR 97224
V13765—sof Chapter 9 (commencing with
, and my License is in full force and effect.
No.: 813480
OWNER -BUILDER DECLARATION
I hireffirm under penalty erjury that I am exempt from the Contractor's State License Law for the
folio ing reason (Sec. 7031. , Business and Professions 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).:
(_ 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 ISec. 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 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:
LQPER y[IT
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 per e o the wo - r which this permit is
j( issued.
I have and will maintain workers' com ation insurance, as required by S tion 3700 of the Labor
Code, for the performance of work for which this p 't is issue y workers' compensation
insurance carrier and poli umber ar
Carrier STATE FUND P ' y mber 98 005
I certify that, in the pe ormance o e ork fo ch t ' permit is issued I shall not em loy any
pers in any manner a workers' compensation laws of California,
an gree that, if I shoul ec esu a workers' compensation provisions of Section
�s1LeK5e Labor Co , I f comply with those provisions.
Datd'.' fes/ Applicants
WA NI FAILURE TO SEC WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJE AN EMPLOYER T 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 emplo c or omis ed to the work being
performed under or following issu this permit.
2. Any permit issu as a resu this application becomes null and void if work is n commenced
within 180 d s from d e of issuance of such pe or cessatio f wo for 18 days will subject
per t07
c cella
tion.
I certify that I ve re this app ion an on is act. I agree o comply with all
city and cr�n ordi nces and state laws relating to nstr ion, representatives
of this aYfn to ar uoon the above-mentioned o er r ins ction Doses.
(Applicant or
Application Number . . . . . 05-00003383
Permit . . . . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 25.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 916
Expiration Date 1/30/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
5.00 2.0000 HND BLDG 501-2,000
10.00
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Special Notes and Comments
20 L.F. 6- GARDEN WALL, 26 L.F. 4 -
GARDEN WALL & 6 L.F. 2' WALL, ALL ORCO
SYSTEM
Fee summary Charged Paid
-- - - - - - - - - - - - - - ------ - - - - ------ - - -
Credited
- ------ - - - - ---
Due
--- - - - - - -
Permit Fee Total 25.00
.00
.00
25.00
_ Plan Check Total .00
.00
.00
.00
Grand Total 25.00
.00
.00
25.00
LQPERMIT