05-3381 (BLCK)_T .O. BOX 1504
r 78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00003381
Property Address: 80818 VIA PUERTA AZUL
APN: 762-240-003-12 -300962-
Application description: WALL/FENCE
Property Zoning: MEDIUM DENSITY RES
Application valuation: 2275
Applicant:
I hereby affirm under penalty of perjury
Section 7060) of pivision 3 of the Buy
Architect or Engineer:
Gis Ater 9 (commencing with
,'End my License is in full force and effect.
No.: 813480
Date —Contractor:
OWNER -BUILDER DECLARATION
I re affirm under penalty of jury that I am exempt from the Contractor's State License Law for the
(lowing 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 155001.:
(_ 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.).
(_ 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.).
(_) 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:
LQPERA11T
Q"
?ARTMENT
MIT
VOICE (760) 777-7012
FAX (760) 7,77-7011
INSPECTIONS (760) 777-7153
Date: 8/03/05
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
issued.
I have and will maintain workers' compensate ante, as req ' ed by Section 3700 of the Labor
Code, for the performance of thew or which this permit is ' sued. My workers' compensation
insurance carrier and policy nu er are:
Carrier STATE FUND Policy ber WC2 892005
I certify that, in the perf5Rfance of ork for whic is permit is issued, I shall not employ any
person in any mann so as to a subject the workers' compensation laws of California,
and agree that, if should subject the workers' compensation provisions of Section
3700 Qf the L Cod orth comply with those provisions.
WARNING: FAILURE TO SESKAE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYERX CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). Y9 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 null olid if work is not co enced
within 180 days from date of issuance of such permit ration of work for 180 d s will subject
permit to cancellation.
I certify that I hav read this application and state that th o ation is correct. I e to comply with all
city and county i=c;e nd state laws relating to ild' uction, and here uthonze representatives
of this county t enter ul the above-mentioned o spection purp
(Applicant or
n
Application Number . . . . . 05-00003381
Permit . . . . .
. WALL/FENCE
PERMIT.
Additional desc .
Permit Fee . . .
. 54.00
Plan Check
Fee
.00
Issue Date
Valuation
2275
Expiration Date
1/30/06
Qty Unit Charge Per
Extension
BASE
FEE
45.00
1.00 9.0000 THOU BLDG
2,001-25;000
9.00
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Special Notes and
Comments
91 L.F. 6' GARDEN
WALL, 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
LQPEENiIT