05-4378 (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:
T4ht 4u�l'ItrGv
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 9/29/05
05-00004378
Owner:
80817 VIA PUERTA AZUL
PUERTA AZUL PARTNERS
762-240-003-76 -300962-
17700 SW UPPER BOONES FERRY RD
WALL/FENCE
Dd
SUITE 100
MEDIUM DENSITY RES
ORTLAND, OR 97224
450
nrT 17
?005
Contractor:
Architect or Engineer:
DAVIS/REED CONSTRUCTION INC
Cl n'AF
F'
169 SAXONY ROAD, SUITE 105
1)ENCINITAS,
CA 92024
(760)634-2350
A
�
Lic. No.: 813480
-- - - - - - - - - - - - - - - - - -
I hereby irm nder pena erjury that
Sec n 000 of Division 3 of the Business a
L' se . 13
at ontractor:
with
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, 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).:
(_) 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 forsale(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
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
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
�issued.
I have and will maintain workers' compensation i ance, as required by Se ion 3700 of the Labor
Code, for the performance of the work fo ich this permit is issued. workers' compensation
insurance carrier and policy number a .
Carrier STATE FUND P c OC29889200
_ certify that, in the performance th r ich this permit ' ssued, I shall not employ any
rson in any manner so a o b to the worke compensation laws of California,
nd agree that�J'should b e wore Section
A 3700.pLeMFfCa ode, 1 comply those provisions.
01
D , ) ` plicant:
W RNI G: FAILURE TO SECURE R ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
S BJ TAN 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 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 issues of this permit.
2. Any permit issued as a re phis application becomes null and void if work is notcommenced
within 760 days from dat of issuance of such permit, or cessation of wo or 1 0 days will subject
permit to cancellation.
I certify that I have re d this application and e a ' is rrect. I ree to comply with all
city and cou ordi nces a ws relating to b ' yyy thorize representatives
of this c n toe er on the ove-mentioned p � cti pu as.
t . i ture (Applicant or n
Application Number
Permit . . .
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
. . . . 05-00004378
WALL/FENCE PERMIT
15.00 Plan Check Fee..
3/28/06 Valuation . . . .
.00
450
Qty Unit Charge Per Extension
BASE FEE 15.00
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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 15.00 .00 .00 15.00
Plan Check Total .00 .00 .00 .00
Grand Total 15.00 .00 .00 15.00
LQPERMIT