05-3390 (BLCK)P.O. BOX 1504
_ 78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05•=00003390
Property Address: 57359'VIA "VISTA
APN: 762-240-003-24 -300962-
Application description: WALL/FENCE
Property. Zoning: MEDIUM DENSITY RES
Application valuation: 2198
Applicant:
- - - Qe
- -. - - ' - - LICENS
I
hereffir r of perjury that) a�S ti 700 i 3 of the Business
Architect or Engineer:
VOICE (760) 777-7012.
FAX (760) 777-7011
U LDI d SAF Y DEPARTMENT INSPECTIONS (760) 777-7153_
,jBUILDIN PER T
Date: 8/03/05
C/ V `Owner:
PUERTA 'AZUL PARTNERS
17700 SW UPPER BOONES FERRY RD
SUITE
PORTLAND, OR 97224
Contractor:
DAVIS/REED CONSTRUCTION INC'
WCC: STATE FUND y
WC: WC298892005 06/30/06
CSLB: 813480 10/31/06
i'S DEC —� �. WORKER'S COMPENSATION DECLARATION -
s of Chapter 9 (commencing with I,hereby affirm under penalty of perjury one of the following declarations:
and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation,.as provided -
No.: for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
• LQPERMIT -
issued.
a on racto - _
I have and will maintain workers'.compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work hich this permit is is ' compensation -
OWNER -BUILDER DECLARATION
insurance carrier and. policy number - -
I h reby firmunderpenalty perjury that I am exempt from the Contractor's State License Law for the -
Carrier B - i Num - - - - - - -- - -•- - - -
fo owing reason (Sec. 7031 .5, Business and Professions Code: - Any city or county that requires a permit to
1 certify that, in the performanc f ich this permit is issued, 1 all not employ any
- c nstruc , alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
_
person in an ner so t me s Yto the workers' compe ion laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State -
and a that, if. I sho a su ' t to the workers' comp ion provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
the Labor C I ith comply with tho ovisions.
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).:
Applicant'
( ) I; as owner of the property, or my employees with wages as their sole compensation, will do the work, and
_
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the structure isnot intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TOSE URE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, -
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANDCIVIL FINES UP TO ONE HUNDRED THOUSAND .. -
and who does the work himself or herself through his or•her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN,
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). - -
APPLICANT ACKNOWLEDGEMENT -
( ,) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. -
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the • -
- 7044, Business and Professions Code: The Contractors' State License.Law does not apply to an owner of
conditions and restrictions set forth on this application. ,
- property who builds or improves thereon, and,who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this ation is made, each person at w request and for
pursuant to the Contractors' State License Law.).
whose benefit work isperfor under or pursuant to any permit issued as a rest f this application,
( 1 1 am exempt under Sec.. , B.&P.C. for this reason -
the owner, and the appl' t; each agrees to, and shall defend, indemnify and hold ha less the City
- -
_
- of La Quinta, its offi rs, agents and employees for any act or omission related to the w k being
performed under or following issuance of this permit.
- -
Date: Owner: - -
2. Any permit issued a result of this application beco u d voi is not com nced
- -
within 180 days fro ate of issuance of such ii cess ark, for 1 ays will subject
• CONSTRUCTION LENDING AGENCY
permit to cancellation.
. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the - -
- I certify that I have read this applicatio and sta on is car .. I agree to comply with all -
. work for which this permit is issued (Sec. 3097, Civ. C.). - -
city and county ordinances a e laws relatin o• n on tion, a ere resentatives
-+ - -
Lender's Name:
oft is ter he above -mention pectio rposes. .
- / - -
l .
i -
D iure (Appli entl: 1
Lender's Address:
• LQPERMIT -
Application Number 05-00003.390
✓E: 1
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Permit WALL/FENCE PERMIT
Additional desc .
Permit-Fee •. . . 54.00 Plan Check
Fee :
00
Issue Date Valuation
2198
:. Expiration Date . • 1/30/06 .
Qty Unit Charge Per
Extension
BASE FEE
45:00
1.'001 9.0000 THOU BLDG 2,001=25,000
9..00
Special Notes and Comments
-
70 L.F. 6' GARDEN WALL, 28 L.F. 4'
• GARDEN. WALL & 6 L . F .. 2 ' WALL , ALL ORCO
SYSTEM.
Fee summary, Charged Paid Credited
Due_
Permit Fee Total 54.00 .00
.00
54:00
Plan Check Total .00 .00..;
.00
00-
Grand Total 54.00. -_00
00
54.00