04-6776 (BLCK)z
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504
(760).777-7012
781495 CALLE TAMPICO
DOF�TI� �sFAX (760) 777-7011
J LLA�Y� UINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
2004 BUILDING PERMIT
CITY®L;,% QUINTA
FINANCE DEPT
Application Number. . . . . . 0.4-00006776; Date 10/14/04
Property Address . . . . . . 80932 VIA PUERTA AZUL
APN: '762�-240-003-7 =300961 -
Application description . . . WALL/FENCE
Property Zoning . . . . . . . MEDIUM DENSITY RES
Application valuation . . . . 650
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
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Permit . . . . . . WALL/FENCE PERMIT
Additional desc
Permit Fee . . . . 19.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 650
Qty Unit Charge Per. Extension
BASE FEE •15.00
2.00 2.0000 HND BLDG 501-2,000 4.00
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Special'Notes and Comments
30 L.F. 5' GARDEN WALL,.ORCO SYSTEM
Fee summary Charged Paid Credited Due
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Permit Fee Total 19.00 .00 .00 19.00
Plan Check Total .00 ..00 .00 .00
Grand Total 19.00 .00 .00 19.00
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: 0 — & 7 % (p Date: /O ' 6 L/
Applicant: 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 p alty of perjury that I am licensed under provisions of Chapter 9 ting with Section 7000) of Division 3 of the Business and Professionals
�ode, and my Licens s full force and effect.
icense Clais �icense No. A013%
OWNER -BUILDER DECLARATION
I here(y affi4 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.).
(, 1, 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 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
f the rk for w ch this permit is issued.
1 ave an will ma' ai workers' compensatio c , required by Section 3700 of the Labor Code, fnr th erf anytobeceome
work for which this permit is
iss ed yav e ' o gnsation i nce carrier and po number are; p �� J
�arrier j olicy Number !/t/ li
I c a the performanc of the rk for whi s permit is i sued, I shall not emplo person in any manner so subject to the workers'
pens i n laws of C omia, a ee th should beco a subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
0 hh% it°�compl with ose provi o
/bate / / / / / Annfirnnt
WARNINF URE/TO SECURE WORKERS' C'6MPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FI ES PTO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTI N 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 K
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, eat es 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 work being performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes nul d void if work is rptcommenced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to cantefration.
1 certify that I have read his application and state that the above in rmation is rrrect. m y with all city and county ordinances and state laws relating to building
construction, a/hery aut orize representatives of this county o enter up he a ne roperty for inspection purposes.
ate L ' Signature (Appliicant or Agent):