05-3393 (BLCK)- . ..,
P:O. BOX 1504 - VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7014
LA QUINTA,-CALIFORNIA 92253 BUI AFETY DEPARTMENT INSPECTIONS (760) 777-7153
+ D UILDAG P
}`'� Date: 8/03/05
Application Number: 05_4 00003393 er
Property Address: 57371 VIA VISTA AUG 3 0 2005 RTA AZUL PARTNERS
APN: 762-240-003-26 -300962 00 SW UPPER BOONES FERRY RD
Application description: WALL/FENCE CffyOFS TE 100
�QU
Property Zoning: MEDIUM DENSITY RES FIy IN1Ti4 P TLAND, OR 97224
Application valuation: 2500 AR10EpEPT
Contractor:
Applicant: Architect or Engineer: DAVIS/REED CONSTRUCTION INC
WCC: STATE FUND
WC: WC 298892005 06/30/06
CSLB: .813480 10/31/06 "
---•-,----,---- -- ---- ----/-------- --------------- -.------------------------------------
- LICE D ONTRAC DECLARATIO - WORKER'S COMPENSATI _LA RATION
hereby affirm under I of perjury that I m ' nsed un r� ovis' apt (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Sectijjj��J^^^ 7000) of i of the Busines an ofession ,-and my Lic a is in full force and effect. _ I have and will maintain acertificate of consent to self-insure for workers' compensation, as provided
Licl icense No.: for by Section 3700 of the Labor Code, for the performance of the work for whichthis permit is
issued.
Dat - Contra I have and will maintain workers' compensation ins re y ec i f the Labor- J
Code,. for the performance of the wo ich this per nsation
- - OW LDER DECLARATION - - insurance_ carrier and policy rare:
• - I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the _ Carrier B P er - - - - - - - - - - - - -
_ , following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to - I rtify t , in th rfor t c for which this perm' issued, I shall not em any -
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the - pers in any r so c e subject to the s' compensation laws alifornia, .
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State an agree that, d o ubject to the r s' compensation pr ns of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3o the Business and Professions Code) or, - _ _ - 00 abor Cod s hwit ply ith those provisi
that he or she is exempt therefrom and the basis for the alleged exemption. •Any"violation of Section 7031.5 by r 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
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WS FAILURE TO SEC WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, S JEC SAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND -
' and, who does the work himself or herself through his or her own employees, provided that the LLA ($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 SECTI N 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 _
(_) I, 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 application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any"permit issued as a res is applicati
(_) I am exempt under Sec. , B.&P.C. for this reason - the owner, and the applicant, each agrees to, and shall defend, indemnif old harmless the City
• of La Quinta, its officers, agents and employees for any act or ion related to the work being
performed under or following issuance of this permi - -
Date: Owner: - - .2. Any permit issued. as a result of this applicat com null i wo is not co 'menced
• - - within 180 days from date of issuan such pe cessation o .o
CONSTRUCTION LENDING AGENCY per it to c cellation --_�
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the . I certify that I ve re this ication and state t b informati i� 'agree to comply with all '
work for which this permit is issued (Sec. 3097, Civ. C.). city an ord' ances nd state laws relati to di constr d eby authorize representatives
- - - of th o to upon the above-mentione s on pu ses.
Lender's Name:
Date: ignature (Applicant or Ag
.Lender's Address:
LQPERMIT -
Application Number _ 05-00003393
Permit• . . . . . WALL/FENCE PERMIT
Additional desc .
} Permit Fee 54.00 '•
Plan Check
Fee
.00 _
Issue Date
Valuation
. . .
25.00
• Expiration Date 1/30/06
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
100 L'. F . 61 -GARDEN WALL , 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
LQPERDIIT