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04-6778 (BLCK)i. Box 1504 495 CALLE TAMPICO QUINTA, CALIFORNIA 92253 44" BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number . . . 04-00006778-� Date 10/14/04 Property Address . . . . .80.920 VIA PUERTA AZUL APN: 762-240-003-9 -300961- Application description . . . WALL/FENCE Property Zoning . . . . . . . MEDIUM DENSITY RES Application valuation . . . . 2516 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 . . . . 54.00 Plan Check.Fee .00 Issue Date . . . . Valuation . . . . 2516 Qty Unit Charge Per Extension BASE FEE 45.00 1.00 9.0000 THOU BLDG 2,001-25,000 9.00 ---------------------------------------------------------------------------- Special Notes and Comments 40 L.F. COMBO WALL, 2' RETAINING, 5' GARDEN, 70 L.F. 5' GARDEN WALL, BOTH ORCO SYSTEM Fee summary ----------------- Permit Fee Total Plan Check. -Total Grand Total Charged Paid 54.00 .00 .00 .00 54.00 00 Credited Due .00 54.00 .00 .00 .00 54.00 P.O. BOX 1504 • VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: 1)4/- 6 % 7 g Date: 0 Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under pe ty of perjury that I am licensed under provisions of Chapter 9 (commencing With Section 70 ) of Division 3 of the Business and Professionals Code, and my Licens in full force and effect. cense Class cense No. VQC / Date ntractor 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 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 th work which this permit is issued. I have d will ain in workers'co on insurance, equired by Section 3700�f the Lab Co , for a erfo�nc% th ork for which this permit is i s d. My orkers' come on insurance carrier and poli number are: l•�� Parrie icy Number �� I certiff that, in a perf anc the work for whi permit is is ued, I s all not employ any person in any manner so as to become subject to the workers' compens or la of California, and t should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall f hwit ompl , ith those provisi Date �pplieant WARNI G: F ILURE TO SECURE W KERS' COMPENSATION COVERAGE IS UNLAWFU , ALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL) IVIL INES UP TO ONE HUNDRE HOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SE ION 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 APPLICANT ACKNOWLEDGEM —�� IMPORTANT Application is hereby made to the Director of Building and Safety for a permit to the condition 1. Each person upon whose behalf this application is made, each person at se request and for whose issued as a result of this application, the owner, and the applicant, ea agrees to, and shall, defend, in officers, agents and employees for any act or omission related to work being performed under or fol 2. Any permit issued as a result of this application becomes nulla void if work isnot commenced wi in cessation of work for 180 days will subject permit to cancella ' n. I certify that I have read th' application and state that the above info tion is core I agree to p ith a ' construction, �here�th9riz� representatives of this county to a ter upon th Ave -me e pr it or _ S' ignature (Applicant or Agent): d restrictions set forth on this application. ben fit work is performed under or pursuant to any permit iemnify and hold harmless the City of La Quinta, its owing issuance of this permit. 180 doys from date of issuance'of such permit, or county ordinances and state laws relating to building on purposes.