05-2815 (BLCK)PA` -BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
X05-00002815
`80854 VIA PUERTA
762-240-003-6
WALL/FENCE
AZUL
-3009
MEDIUM DENSITY RES
1336
I hereby affirm under penalty of perjury
Section 7000) of Division 3 of the Busi
License Class:
/ate ntractor: /
Tdv1 °f 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect
�)1fk
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:
DAVIS/REED CONSTRUCTION INC
169 SAXONY ROAD, SUITE 105
ENCINITAS, CA 92024
(760)634-2350
Lic. No.: 813480
Date: 7/08/05
---- - - - - --—------------------------------------------------------- - - - - - —
is in full force and effect.
f_ 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).:
1 _ 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, 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—) Fam 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: PC
LQPERMff
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.
have and will maintain wor pensation insurance, as re Section 3700 of the Labor
Code, for the pe once of the work for which this permit is issued. iiikers'
insurance ier and policy number are:
Carrier STATE F FI3 Policy Nuai WC 920 5'
_ I certify I at, in the performance of the yy�efk r whi gh s per ' , s issued, I shall not em loy any
person i nv manner so as to be�errie ject a wo rs' compensation Ia f -California,
and agree that, if I s ou ec ompensation p_Lovi ons of Section
3700 a Labor Code, I Kall i ompl I those prow
bate: icanv
WARNING: FAILURE TO SECUR RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN 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 fora 'on related to the work being.
performed under or following issuance of ,mit.
h' p icati
2. Any permit issued as a result of ton becomes null and void if work is not commenced
within 180 days from date suance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this ap ' ation and state that the ab information is ect. I agree to comply with all
city and county ordinances a laws relating to bui ' g structio d hereb a "sentativas
of this county tryenter up n t e above-mentioned p rt inspec ' purpo
Date�� `7L ignature (Applicant
Application Number . . . . . 05-00002815
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 33.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 1336
Expiration Date . . 1/04/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
9.00 2.0000 HND BLDG 501-2,000
18.00
----------------------------------------------------------------------------
Special Notes and Comments.
40 L.F. 6' GARDEN WALL, 21 L.F. 4'
GARDEN WALL, 6 L.F. 2' GARDEN WALL, ALL
ORCO SYSTEM
Fee summary Charged Paid Credited
---------------------------
Due
--------------------
Permit Fee Total 33.00 .00
----------
.00
33.00
Plan Check Total .00 .00
.00
.00
Grand Total 33.00 .00
.00
33.00
LQPERMIT