Loading...
04-6780 (BLCK)0 z o Pa V BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 1pF-Ti%­78�,� �5 CALLE TAMPICO FAX (760) 777-7011 INTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT SCG (� Y �;a �hD�C94la Ap,, l� 'Cat on N•urrYber' . . . . . 04-00006780 Date 10/14/04 roperty Address . . . . . . 80914 VIA PUERTA AZUL APN: 762-240-003-10 -300961- Application description . . WALL/FENCE Property Zoning . . . . . . MEDIUM DENSITY RES Application valuation . . . . 758 Owner 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 (760) 634-2350 WCC: STATE FUND WC: WC298892004 06/12/05 CSLB: 813480 10/31/04 CCC: B ---------------------------------------------------------------------------- Permit . . ... . . WALL/FENCE PERMIT Additional desc Permit Fee . . . . 21.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 758 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' BLOCK WALL, 8 L.F. 2' BLOCK 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 P.O. BOX 1504 • VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 04- & 780 Applicant: Applicant's Mailing Address: Date: to • N • o y Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECTION I hereby affirm under penaDy of perjury that I am licensed under provisions of Chapter 9 (co enEn *t Section 7000) of Division 3 of the Business and Professionals ode, and ss Lice ii full force and effect. =� j License Class, �icense No. OWNER -BUILDER DECLARA`fION I here/y affirm u der 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 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 h e al 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 th ork fo hic this permit is issued. ave nd will intain workers' compensation insurance, as required by Section 3700 of the La�jo or #�e performance;ofhe rk for which this permit is f M1 orcer 'c pe sation insyra�ce carrier and policy number are:�e� crier tic mber----_._ _ 1' ertI y that, in the perfo anc a work for which this perm'gX>bct shall not employ any person in any manner so as to become subject to the workers' co en Ibn laws of i omia, and agre� at, if I sho to the workers' compensation provisions of Section 3700 of the Labor Code, I shall f�w omp_y with ose provisions.,/ A /AILURE TO SECURE WORAERS' COMPEPISATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND _S UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN 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 JDA 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 g perferfaeQ`under or following issuance of this permit. 2. Any permit issued as a result of this application becomes n void if work i of co menced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cellation. I certify that I hav read this application and state that the ve informati I to com with all city and county ordinances and state laws relating to building construction, an here authorize representatives of s county to en a ention roperty for inspection purposes. .1�te (J Signature (Applicant or Agent):