04-6781 (BLCK)T4hf 4 4 a"
Box 1504
5 CALLE TAMPICO
UINTA, CALIFORNIA 92253
BUILDING PERMIT
Application Number
Property Address . . . .
APN:
Application description
Property Zoning
Application valuation
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
'04.-00006781
i 80.908 VIA PUERTA AZUL
762-240-003-11-300961-
WALL/FENCE
MEDIUM DENSITY RES
498
Owner
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PUERTA AZUL PARTNERS
17700 SW UPPER BOONES FERRY RD
SUITE 100
PORTLAND OR 97224
Contractor
Date 10/14/04
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 10/31/04
CCC: B
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Permit . . . . . . WALL/FENCE PERMIT
Additional desc
Permit Fee . . . . 15.00 Plan Check Fee.. .00
Issue Date . . . . Valuation . . . . 498
Qty Unit Charge Per Extension
BASE FEE 15.00
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Special Notes and Comments
23 L.F. 5' BLOCK WALL, ORCO SYSTEM
Fee summary Charged Paid Credited Due
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Permit Fee Total 15.00 .00 .00 15.00
Plan Check Total .00 .00 .00 .00
Grand Total 15.00 .00 .00 15.00
9
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: Z//— & 7 S II Date: /D A - 0 44
Applicant: Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
0 /p
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penal f perjury that I am licensed under provisions of Chapter 9 (commencing with Section 700 ) of Division 3 of the Business and Professionals
Code, and my License is in rce and effect. '�
�icense Class icense No. n L3 %6 yJ
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 applicant for 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 build6 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. , B.& 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.
VL Dave and will mai ain workers' compensation insurance, as required by Section 3700 of the Labor Code for the, perfor ante o he work for which this permit is
i su w ers' compensation i a er an po ber are. _U `i
Number
I certify that, in t e performance a work for ich this pe ' is' sued, I all not employ ny person in any manner so as to become subject to the workers'
compens tion laws of Calif ia, and agre at, if I shoul subject the workers' compensation provisions of Section 3700 of the Labor Code, I shall
f rthwitn coomplly with thos provisions.
Crate C v/ pplicant
WARN! : F LURE TO SECURE WORK COMPENSA COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL NE PTO ONE HUNDRED THOUSAND DOLLARS ($100, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SEC ON 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S S.
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
Lenders Address 0 1A
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 applic ac i agre , and shall, defend, indemnify and hold harmless the City of La Quinta, its
officers, agents and employees for any act or omission rel d to the work being p ormed under or following issuance of this permit.
2. Any permit issued as a result of this application become null and void if work is not mmenced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to ca cellation.
I certify that I have read th! application and state that the above in s ree comply with all city and county ordinances and state laws relating to building
construction, an ereby uthori representatives of this county to ente o a e- ioned property for inspection purposes.
ate Signature (Applicant or Agent):