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04-6775 (BLCK)C&4f 4 4 a" P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number . . . . . 0-4 0000677-5 Property Address . . . . . 7\80938 VIA PUERT_A APN: 762-240-003-6 Application description . . . WALL/FENCE Property Zoning . . . . . . . MEDIUM DENSITY R Application valuation . . . . 433 1 Owner PUERTA AZUL PARTNERS 17700 SW UPPER BOONES FERRY RD SUITE 100 PORTLAND OR 97224 Date 10/14/04 2004 Contractor C17)yOFl.Q(gUINTA 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 . . . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 433 Qty Unit Charge Per Extension BASE FEE 15.00 ----------------------------------------------------------------------------- Special Notes and Comments 20 L.F. 51GARDEN WALL ORCO SYSTEM Fee summary Charged Paid Credited Due --------------------------------------------------------- Permit Fee Total 15.00 .00 .00 15.00 Plan Check Total .00 .00 .00 .00 Grand Total 15.00 .00 .00 15.00 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: Applicant: Applicant's Mailing Address: u Date: /A • /W.e Architect or Engineer: Architect or Engineer's Address: Lic. No.: N /,49 BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under pe al of perjury that I am licensed under provisions of Chapter 9 (comme cin with Section 7000) of Division 3 of the Business and Professionals Code, and my License i n II force and effect. /License Clas icense No. / Dat . Contractor , r / OWNER -BUILDER DECLARATION I her y 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 nt intended or offered for sale (Sec. 7044, o 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 yJ 9f the w rk for which this permit is issued. ve an will m tai workers' compensation insurance, as required by Section 3700 of the Labor Code, for the pert rma e.of the work for which this permit is i s y w om ensation�psurance carni olicy numbs a�ejC �Q �rrieriPolicy er GG 1 certify that, in the perform ce of the for which this permit is i sued, I shall not employ any person in any manner so as to become subject to the workers' compen tion laws of California, d agree at, if I should co subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall fdrthwcomply with those pr isions. �i� YFAILURE TO SECURE WORK COMPENSATION COVERAGE IS UNLAWFUL, AND -SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND -S UP TO ONE HUNDRED THO SAND 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 Lenders Address r1 APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit suecFle the sea 'tion 1. Each person upon whose behalf this application is made, each person at a request request and for who issued as a result of this application, the owner, and the applicant, a agrees to, and shall, defend, it officers, agents and employees for any act or omission related a work being performed under or fol 2. Any permit issued as a result of this application becomes n and void if work is not commenced within cessation of work for 180 days will subject permit to cantation. ' I certify that I have re this application and state that the above info ation is co e 1 mply v construction n/d h eby .uJaerize representatives of this county to to o oned e at l� Sig' nature (Applicant or Agent): and restrictions set forth on this application. benefit work is performed under or pursuant to any permit aemnify and hold harmless the City of La Quinta, its Awing issuance of this permit. ,180 days from date of issuance of such permit, or SII city and county ordinances and state laws relating to building for inspection purposes.