04-5583 (BLCK)ul�cv
BUILDING '& SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (76.0).777-7153
BUILDING PERMIT
Application Number
Property Address
APN:
Application description
Property Zoning
Application valuation-
owner
aluation-
Owner --
PUERTA AZUL PARTNERS
17700 SW. -UPPER . BOONES FERRY RD
SUITE 100 OR 97224
PORTLAND
04-00005583 Date 7/20/04
80919 VIA-PUERTA AZUL
762=240-003-22 -300961'-
WALL/FENCE
MEDIUM DENSITY RES
2295.
Contractor
DAVIS/REED R�ADTRSTEION #105INC
169 SAXO CA 92024
ENCINITAS
(760) 634-2350
WCC: STATE FUND 06/12/05
WC: WC298892004 10/31/04
CSLB: 813480
CCC: B
-----Permit WALL/FENCE PERMIT
.00
Additional desc Plan Check Fee
Permit Fee 54.00 2295
Valuation
Issue.Date
Extension
Qty Unit Charge Per. 45.00
BASE FEE 9.00
1.00 9.0000 THOU BLDG 2,001-25,000 -----------------
---------------------------
Special Notes and Comments
VED
106 LF 5' BLOCK WALL PER CITYOSTANDARD.
PRECISE GRADING PLAN AND
Paid Credited Due
Fee summary --_- Charged ____-__
-------
------ -----54.00 .00 0 54.00
.00
Permit Fee Total �, .00
Plan Check Total • 00 . 00 �o� .4.00
Grand Total 54.00
P.O. BOX 1504
78-495 CALLS TAMP.ICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number: b
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7.153
Date.
Architect or Engineer's Address:
Lic. No.,
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my License is in II force and effect.
License Clasv\
License No.
Date Contractor .
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 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
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 h this permit is issued.
�ean ill int in workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit'is
ensation insurance carrier and policy number are: sY� �'9®5?
Cartier Policy Number G(/
I c6ffify that, in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, l shall
fo mply with those provisions. S
Date Applicant
WAR G: 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 r uest 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 s o, an hall, defend, indemnify and hold harmless the City of La Ouinta, its
officers, agents and employees for any act or omission related to ork being performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null d void if work is not commenced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to cance
tion.
I certify that I have read this application and state that the above in ation is co I ag t with city and county ordinances and state laws relating to building
construction, ate% hereauthorize representatives of this county t enter upo abov props for inspection purposes.
Data
"' /� Signature (Applicant or Agent): 09