05-4375 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: W05-000,04375
Property Address: 80811 VIA PUERTA AZUL
APN: 762-240-003-73 -300962-
Application description: WALL/FENCE
Property Zoning: MEDIUM DENSITY RES
Application valuation: 1625
Applicant:
I hereby in ndel/penalty c
Section 0001 of
3 of
License lass: B
TiAt 4 4 Q"
Architect or Enginee@
pIka
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
CTOR'S DECLARATION
under provisions of Chapter 9 (commencing with
pals Code, and my License is in full force and effect.
License No.: 813480
V OWNER -BUILDER DECLARATION
I hereb�affi under penalty of perjury that I am exempt from the Contractor's State License Law for the
following re on (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, a er, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to fil 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, 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. B.&P.C. for this reason
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
PUERTA AZUL PARTNERS
17700 SW UPPER BOONES FERRY RD
SUITE 100
PORTLAND, OR 97224
Contractor:
^oo[ DAVIS/REED CONSTRUCTION INC
169 SAXONY ROAD, SUITE 105
ENCINITAS, CA 92024
®¢� (760)634-2350
Lic . No.: 813480
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
Date: 9/29/05
-----------------------------------------------
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 Lab Ie,—for-the performance of the work for which this permit is
issued.
I have and will maint . workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the p ormance�..fyi the work for which this permit is issued. My workers' compensation
insurance carri nand oolic4,humVer are:
Carrier zSTAJYE FUND ^ / / //Poljl:fy Number WC298%920
certify th , in the r nc f t wor is issued, I shall not employ any
pers in any manner as me subie o t e worker ' compensation laws of California,
a agree that, if I o Id co subject the orkers' c mpensation provisions of Section
3700 of the Labo e', sh I orthw' comply ith t e provisions.
I: FAILURE TO SECUR ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
AN EMPLOYER TO CRIMINAL 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 , an defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and em ogees for a y act or omission related to the work being
performed unde,-Dr maowing issuance,/of this permit.
4coinances
rmit' ed as a result of this ppli ti n beco s null and void if work is not commenced
days from date of issu nce h pe'r ' , or cessation of r 180 days will subject
to cancellation.
Wc read this application and sta information is correct. I agree to comply with all
and state laws relati it ' g construction, and hereby authorize representatives
;eer upo the above-mentio y for inspection purposes.
Signature (Applicant or t):
Application Number . . . . . 05-00004375
Permit . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . . 39.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 1625
Expiration Date . . 3/28/06
Qty Unit Charge Per
Extension
BASE
FEE
15.00
12.00 2.0000 HND BLDG
----------------------------------------------------------------------------
501-2,000
24.00
Special Notes and Comments
65 L.F. 6' & 60 L.F. 2' BLOCK WALLS,
BOTH ORCO SYSTEM
Fee summary Charged
=---------
Paid Credited
Due
---------------------------
Permit Fee Total 39.00
----------
.00
----------
.00
39.00
Plan Check Total .00
.00
.00
.00
Grand Total 39.00
.00
.00
39.00
LQPERMIT