05-2813 (BLCK)P.0."BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: --05=00002813 ,
Property Address: 80866 VIA PUERTA AZUL
APN: 762-240-003-4 -300962-
Application description: WALL/FENCE
Property Zoning: MEDIUM DENSITY RES
Application valuation: 2200
Applicant:
I hereby affirm under penal
Section 7000) of Division3 of
License Class: $
Architect or Engineer:
LLICENSED
jury that I am li ns un
Business and rof sio C
P
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
PUERTA AZUL PARTNERS
lyY40)
17700SW UPPER BOONES FERRY RD
SUITE 100
PORTLAND, OR 97224
4 2005
Contractor:
nffp QUIIN41TA DAVIS/REED CONSTRUCTION INC
169 SAXONY ROAD, SUITE 105
ENCINITAS, CA 92024
(760)634-2350
Lic. No.: 813480
eer 9 (commencing with
se isin full for e
80
,Date: �rac or: f/'
/ OWI R -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.).
(_) I, as owner of the property, amexclusivelycontracting 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:
LQPERMIT
Date: 7/08/05
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ 1 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.
_11-Fhave and will maintain workers' compensatio nce, as required -by -Section 3700 of the Labor
Code, for the performance of the or which this permit is issued. My workers' compensation
insurance carrier and policy er are:
Carrier STATE FUND Policy Number WC298 2005
I certify that, in the p ormance of the work irtwhic i ermit i ' sued, I shall not employ any
person in any nner so as to be a subor mpensation laws of California,
and ogre , if I should bet lett or s' c pensation provision sof Section
�. 370 f th Libor Code, I with y ith tho e provisions.
nate, <- / / - vv ppucant
WARNING: FAILURE TO SECURE I&ORKERS' 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.
i. 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 o ees for any act or omission related to the work being
performed under or folio ' g issuance of this permit.
2. Any permit issued as a r suit of this application becomes null and void if work is not commenced
within 180 days from de of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
1 certify that I have read this application an to that the above ' rmation is c rhe to comply with all
city and county ordinances and state laws relatin ildin on truction authorize representatives
of this count toe er upon the above-mentioned prope s.
Dat
of
(Applicant or Age
Application Number . . . . . 05-00002813
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 54.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 2200
Expiration Date 1/04/06
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
88 L.F. 6' GARDEN WALL,ORCO SYSTEM
Fee summary Charged
----------------- ----------
Permit Fee Total 54.00
Plan Check Total .00
Grand Total 54.00
LQPERMIT
Paid Credited Due
---------- ---------- ----------
.00 .00 54.00
.00 .00 .00
.00 .00 54.00