05-2811 (BLCK)O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
C&t!t 4�Q�w
Application Number:
�0 '0000281�1,
Property Address:
80878 VIA PUERTA AZUL
APN:
762-240-003-2 -300962-
Application description:
WALL/FENCE
Property Zoning:
MEDIUM DENSITY RES
Application valuation:
758
Applicant:
j Architect or Engineer:
PtA
I hereby affirm under penalty of perjury that I
Section 7000) of Division ,of the Busines <
License Class:. B
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
D
t
.l2005
CITY OF LA QUINTA
FINANCE DEPT.
I (commencing with
in full force and effe
OWNER-BUIbOER DEL-LARATION
I hereby affirm under penalty of perjury at 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 1$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 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.).
(_ 1 I am exempt under Sec. , BAP.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
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.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for it is issued. My workers' compensation
insurance carrier and policy n are:
Carrier STATE FUND Policy Number WC298892005
I certify that, in the pe rmance of the work for which this p it is i ed, I sh not employ any
person in any ma ner so as to becgme subject t , e ers' pensation I of California,
and agree that, if
out
beco ec t e w ers' c pensation prow ns of Section
WARNING: FAILURE TO SECURE WORKERS' 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 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 applicatio omes null and void if war commenced
within 160 days from date of issuance ch permit, or cessation of work for 180 days,\\ will subject
permit to cancellation.
I certify that I have read this application ands a that the above information is correct. LAgree to comply with all
city a�AA�
countate laws re ting to building const ion, and here - uthorize representatives
off INbove-mens ned property for' / on purpo •/
Date:pplicant or Ag tl: .4
Application Number . . . 05-00002811
Permit . .
. WALL/FENCE PERMIT
Additional desc .
Permit Fee . . .
. 21.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 758
Expiration Date
1/04/06
Qty Unit Charge Per
Extension
BASE
FEE
15.00
3.00 2.0000 HND BLDG
501-2,000
6.00
----------------------------------------------------------------------------
Special Notes and
Comments
35 L.F. 5' GARDEN
WALL, 6 L.F. 2 -
GARDEN WALL, BOTH
ORCO SYSTEM
Fee summary
-----------------
Charged
Paid Credited
Due
Permit Fee Total
--------------------
21.00.
----------
.00
----------
.00
21.00
Plan Check Total
.00
.00
.00
.00
Grand Total
21.00
.00
.00
21.00
LQPERMIT