04-5582 (BLCK)P.O. Box 1504
78-495 CALLE TAMPICO
LA QUIN TA, 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).77777012
FAX (760) 777-7011
INSPECTION REQUESTS (760) .777-7153
04-00005582 Date 7/20/•04
80913 VIA PUERTA AZUL
762-240-003-21 -300961-
WALL/FENCE
MEDIUM DENSITY RES
3901
Contractor
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 10/31/04
CCC:. B
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Permit WALL/FENCE PERMIT
Additional desc
Permit Fee . . . . 63.00 Plan Check.Fee .00
Issue Date Valuation 3901
Qty Unit Charge Per Extension
BASE FEE 45.00
2.00 9.0000 THOU BLDG 2,001-25,000 18.00
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Special Notes and Comments
70 LF COMBO 3' RETAINING WITH 21GARDEN
WALL/88 LF 5' GARDEN WALL/30 LF 3'
RETAINING WALL PER CITY STANDARD AND
APPROVED PRECISE GRADING.PLAN.
Fee summary Charged Paid. Credited Due
---------------------------------------------------------
Permit Fee Total 63.00 .00 .00 63.00
Plan Check Total .00 %C11TY
a@ 00
Grand Total 63..'00�.00 63.00
pU1NTADEPT.
P.O. Box 1504 •
VOICE (760) 777-7012
78-495 CALLE TAMFICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7.153
Application Number: O Y— J
Applicant:
Applicant's Mailing Address:
BUILDING & SAFETY DEPARTMENT
Date: 4
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalt of perjury that I am licensed under provisions of Chapter 9 (qammenctng with Section 7000) of Division 3 of the Business and Professionals
Code, and my License is 1 force and effect. C`(�
License Class License No.
j�
Date q Contractor �l `�� ( ^�- �',�' "�--•
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 Ucense 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 1, 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.).
V 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 thwork for which this permit is issued.
_ I ave nd will ' ain workers' compensation insurance, as required by Section 3700 of the Labyrsn
for the performance of the work for which this permit is
' s My orlc rs' ce nsation insurance Cartier d n b (�,
Cartier —Policy Number
Z��
_ I certify that, in the performance of the work for which is permit is issued, I shall not employ any any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the wo ers' compensation provisions of Section 3700 of the Labor Cade, I shall
fo co ply with those provisions.
Date Applicant ��V.�'►-fes' —C
WARNG: AILURE 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.
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
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 to, and shall, defend, indemnify and hold harmless the City of La Ouinta, its
officers, agents and employees for any act or omission related tot iork being performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null void if work is not an within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to cance ion.
I certify that I have read is application and state that the above inf afion is ct I ply with all city and county ordinances and state laws relating to building
construction, an ere authorize representatives of this county t enter u e a ed p arty for inspection purposes.
Date Signature (Applicant or Agent):