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04-5717 (BLCK)T4hf °F 4 Q" P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT Application Number . . Property Address . . . APN: Application description Property Zoning . . . . Application valuation . Owner ------------------------ PUERTA AZUL PARTNERS BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 =-04-00005717 -_ Date . . . 80956 VIA PUERTA AZUL 762-240-003-3 -300961- . . . WALL/FENCE . . . MEDIUM DENSITY RES . . . 1840 17700 SW UPPER BOONES FERRY RD SUITE 100 PORTLAND OR 97224 Contractor 7/26/04 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 . . . . •43.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 1840 Qty Unit Charge Per Extension BASE FEE 15.00 14.00 2.0000 HND BLDG 50172,000 28.00 ---------------------------------------------------------------------------- Special Notes and Comments 85 L.F. 5' GARDEN WALL ORCO SYSTEM, PER APPROVED PRECISE GRADING PLAN Fee summary Charged Paid ----------------- ---------- ----------- Permit Fee Total 43.00 .00 Plan Check Total .00 .00 Grand Total 43.00 .00 Credited Due` ---------- ---------- .00 43.00 .00 .00 .00 43.00 'F-juL ? 5 2004 CITY OF LA QUINTA FINANCE DEPT. P.O. BOX 1504 • VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date: % -,;Z & - O Architect or Engineer: 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 i i ull force and effect. ) License Class / ;1 -<i-cense No. / 3�� ,L Date �P t/ ontractor '91 M iaz O 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. , B.& 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 of the work for which this permit is issued. I q8ve a d will malrtpin workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is i u My rkers' comp ation i rance carrier a olii umb e' �( timer t olicy Number �/�/(r'�/7 _ I i th , in the perforrtr nce of the work for which this miit is issued, I s all not employ an pe 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, I shall /forthwithjomply with those Drovisions. _ Date `a' pplicant V� Y%' --��� WAR NG: F URE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES PTO 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 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 work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if eFe menced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellatio I certify that I have read this application and state that the above inform ' n ' correct. a to I ith all city and county ordinances and state laws relating to building construction, and hereby a horize representatives of this county to on th perty for inspection purposes. �fSte ignature (Applicant or Agent):