04-7666 (BLCK)P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
Application Number . . .
Property Address . . . .
APN:
Application description
Property Zoning . . . . .
Application valuation . .
Owner
PUERTA AZUL PARTNERS
17700 SW UPPER BOONES FERRY RD
SUITE 100
PORTLAND OR 97224
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
_04-00007666
80877 VIA PUERTA AZUL
762-240-003-15-300961-
WALL/FENCE
MEDIUM DENSITY RES
2598
Contractor
Date 12/08/04
DAVIS/REED CONSTRUCTION INC
169 SAXONY ROAD, STE #105
ENCINITAS CA 92024
(760) 634-2350
WCC: STATE FUND
WC: WC298892004 06/12/05
CSLB: 813480 10/31/06
CCC: B
-----------------------------------------------------------------------------
Permit . . . . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 54.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 2598
Qty Unit Charge Per Extension
BASE FEE 45.00
1.00 9.0000 THOU .BLDG 2,001-25,000 9.00
----------------------------------------------------------------------------
Special Notes and Comments
120 L.F. 5' 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
LL„
P.O. BOX 1504 •
VOICE (760) 777-7012
75-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: _ 6_41- 7 & (A b Date:
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
0 d�
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalt rjury that I am licensed under provisions of Chapter 9 (comme . g with Section 7000) of Division 3 of the Business and Professionals
�Co e, and my Lice se is i II f e and effect.
nse Clas ,cense No.
,
Dat J ontractor.2h45 r
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 applicantfor the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' 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).):
U 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 or 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.).
U 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.).
U I am exempt under Sec. , BA P.C. for this reason
Date Owner
WORKERS' 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 t or which this permit is issued.
I ha eN' nd ill maintain workers' compensati insurance, as required by Section 3700 of the Labor Code, for the -performance of the �vyyaorr��cc for which this permit is
My workers' compensation i ante tarn o,cy num re:
Carrier olicy Nu
_ I certify that, in the performance of thn2! ed, I sh I of employ any per56n in any manner so as to become subject to the workers'
compensation laws of California, aject t the workers' compensation provisions of Section 3700 of the Labor Code, I shall
j°rth 'th pomply with those prc
/. r2"AI �_,
WARN Gr' FAILURE TO SECURE WORKE MPENSATION COVERAGE IS AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVILTINES UP TO ONE HUNDRED THOUSXIND DOLLARS ($100,000), IN ADDITION TO THE C F–COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building an or a permit subject to ithRe—c-omm-mogand restrictions set forth on this application.
1. Each person upon whose behalf this application i e, each person at whose request and for whose b t workis performed under or pursuant to any permit
issued as a result of this application, the o and the applicant, each agrees to, and shall, defend, indemni nd hold harmless the City of La Quinta, its
officers, agents and employees for an t or omission related to the work being performed under or following issnce of this permit.
2. Any permit issued as a result of this a s=not mmenced within 180 days f m date of issuance of such permit, or
cessation of work for 180 days will subject permit to cancellation.
I certify thatI have a his application and state that the above informati s rte o co with all city and co ty ordinances and state laws relating to building
construction
, an er y a orize representatives of this county to ent u th a roperty for inspecti purposes.
ate • Signature (Applicant or Agent):