05-3379 (BLCK)_r-
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
`05-00003379;
Property Address:
80830 VIA PUERTA AZUL
APN:
762-240-003-10 -300962-
Application description:
WALL/FENCE
Property Zoning:
MEDIUM DENSITY RES
Application valuation:
916
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:
Applicant: Architect or Engineer: DAVIS/REED CONSTRUCTION INC
169 SAXONY ROAD, SUITE 105
ENCINITAS, CA 92024
(760) 63
LiC. No..:: 813 813480
LICENSED
I hereby affirm under penalty�theusiness
that I am lic
Section 70 0) of Division and
License CI s: B
of C ter 9 (commencing with
V,kTcense is in full force and effect.
(j � v
O R -BUILDER DECLARATION
I hereby off' m under penalty of r' y that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5 siness 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 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, 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 (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
Date: 8/03/05
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -i or workers' compensation, as p •dPSi
for by Section 3700 of the Labor Code, for t rformance of the work for which this permit is
issued.
_ I have and will maintain workers' co nsation insurance, as required by Section 3700 of the Labor
Code, for the per of work for which this permit is issued. My workers' compensatio
insurance carrier and poli number are:
Carrier STATE FUND Policy Nu er WC2 005
_ I certify that, in the p ormance of the w for hich is mit is is d, I shall no ploy any
persorH.n any ner so as to bec a su ' ct to a rkers' c pensation I of California,
// and ;Free th , if �ld beco su ' to t w ers' co ensatio n
of thgastTo-r Code, I
LURE TO SEA�UrRPRKVS'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
OPLOYER TENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
),0001. IN 0 THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
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 he work being
performed under or following issuance of this perm
2. Any permit issued as a result of thisap ecomes null and void if work is not commenced
within 180 days from date of issu ce of such permit, or cessatio f work for 180 days will subject
permit to ca ellation.
I certify that I we rea is application and state t -1 nrpp m comply with aV
city an�ro.rdin�a:eos and state I wsrelating to building cons , and h authorize represents ' s
of thispove-mentioned grope/rtyfor' n pur
QPre (Applicant or Agentl✓
Application Number . . . . . 05-00003379
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
LQPERAIIT