05-2819 (BLCK)P.0-.- sOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:c 05-00002819
Property Address: `-80835 VIA PUERTA AZUL
APN: 762-240-003-77 .-300962-
Application description: WALL/FENCE
Property Zoning: MEDIUM DENSITY RES
Application valuation: 3799
Applicant:
I hereby affirm under penalty of
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Lice se CI s:
D e: ntracti
Architect or
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BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
D �
e :JUL 142005
CITY OF LA QUINTA
i Chapter 9 (commencing with
License is in full force and effect.
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 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 1, 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: N &
{�
Lender's Address: W
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/08/05
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.
ave and will maintain workers' co n insurance, d by Section 3700 of the Labor
Code, for the performance a work for which this permit is issue y workers' compensation
insurance carrier and icy number are:
Carrier STATE FUND Policv w0er Wly 10Jf 92005
I certify that, i e performance of th for w ' rmit is issued, 1 yfiall not employ any
person in ny manner so as to c e subie t o rs' compenAatrbn laws of California,
and agree , ' on provisions of Section
370. the Labor Code h those visions.
WARNING: FAILURE TO WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOY CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). N 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 and void if work is not commenced
within 180 days from date of issuance of such pe of work for 180 days will subject
permit to cancellation.
certify that I have read this application and state t t the above information is correct. I agre - comply with all
city and county ordinances and state laws relating to ilding struction, and here ori repr tatives
of this county o of empon he above-mentioned prope ction pur
DD 't ignature (Applicant or Age
Application Number . . . . . 05-00.002819
Permit . . . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 63.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 3799
Expiration Date . . 1/04/06
Qty Unit Charge Per Extension
BASE FEE 45.00
2.00 9.0000 THOU BLDG 2,001-25,000 18.00
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Special Notes and Comments
100 L.F. COMBO WALL, 1' RETAINING, 6'
GARDEN, 60 L.F.. COMBO WALL, 1'
RETAINING, 4- GARDEN, ALL ORCO SYSTEM
Fee summary Charged Paid Credited Due
-------------------------------------'--------------------
Permit Fee Total 63.00 .00 .00 63.00
Plan Check Total .00 .00 .00 .00
Grand Total 63.00 .00 .00 63.00
LQPERMIT