04-7667 (BLCK)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . . 04-00007667 Date 12/08/04
Property Address . . . . . . 80883 VIA PUERTA AZUL
APN: 762-240-003-16 -300961-
Application description . . . WALL/FENCE
Property Zoning . . . . . . . MEDIUM DENSITY RES
Application valuation . . . . 2949
Owner
-7 ----------------------
PUERTA AZUL PARTNERS
17700 SW UPPER BOONES FERRY RD
SUITE 100
PORTLAND OR 97224
Contractor
DAVIS/REED CONSTRUCTION INC
169 SAXONY ROAD, STE #105
ENCINITAS CA -92024
(76 0) 634-2350
WCC: STATE FUND
WC: WC298892004 06/12/05
CSLB: 813480 10/31/06
CCC: B
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Permit . . . . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee 54.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 2949
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
90 L.F. 5' GARDEN WALL, 40 L.F. COMBO
WALL, 2' RETAINING, 4' GARDEN, ALL ORCO
SYSTEM
Fee summary Charged Paid
----------------- ---------- ----------
Permit Fee Total 54.00 .00
Plan Check Total .00 .00
Grand Total 54.00 .00
Credited Due
---------- ----------
.00 54.00
.00. .00
.00 54.00
P.O. Box 1504 •
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: - -7 Uo i I Date: /)-, E , O `/
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address:
A
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm u6der poae4y�pf perjury that I am licensed under provisions of ChapteL2 (comma cin wi 0 7000) of Division 3 of the Business and Professionals
Code, and my Li nse is i p( force and effect.
License Class License No.
--Date/ LnMnr
� 2�
OWNER -BUILDER DECLARATION
I hereby affirm nder penalty of perjury that 1 am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county hat requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the'pernit 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 fora 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 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
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 the work for which this permit is issued.
have and w0lKa—inTain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work r which this permit is
is workers' compensationjaeuMnc an po icy r are
�Garrier Po' umber �% f
_ I certif hat, n the performance o e work for w ' h this pe sued, I' hall not employ an�r�e6rn y mann to beco a subject to the workers'
pensation laws of Cali ia, and agree t, if I sho me subj t to the workers' compensation provisions of Section 37: 0 of the Labor Code, I shall
oJIfiwitlVomply with t e provisions.
WARNIN& FjAILURE TO SECURE WORK92S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVILES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECT ON 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 IP
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 upori 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 applican�rees to, an s h efend, indemnify and hold harmless the City of La Quinta, its
officers, agents and employees for any act or omission gel0 ork being performed undb{ or following issuance of this permit.
2. Any permit issued as a result of this application beco id ifwo'of commenced Within 180 days from date of issuance of such permit, or
cessation of w rk for 180 dayswill subject permi tanonI certify that I have ad is application and state that t bove in n is gree to tom with all city and county ordinances and state laws relating to building
cons tion, and er authorizelepresentatives o is count o erup v,-mentio property for inspection purposes.
Signature (Applicant