05-3391 (BLCK)r
.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253' LDI & S ETY D RTMENT INSPECTIONS (760) 777-7153
BUILDING PE IT
3 f Date: 8/03/05
Application Number,, r05_- 03391_ _ AUGhi O �oo� Owner:
Property Address: 57365 VIA VISTA PUERTA AZUL PARTNERS
CITY OF Lai► QLIINTA
APN: 762-240-003-25 -300962- 17700 :SW UPPER BOONES'FERRY_RD
Application description: WALL/FENCE FINANCE DEPT SUITE 100
;Property Zoning: MEDIUM DENSITY RES PORTLAND, OR 97224
Application valuation: 1825 ,
Contractor.
Applicant`. Architect or Engineer: DAVIS/REED CONSTRUCTION INC
WCC: STATE FUND
'WC: WC298892005 .' 06/30/06
CSLB 813480 10/31/06
.LICENSED ON T A LARATION - .. '---"" WORKER'S COMPENSATION DECLARATION
.. I hereby affirm and enalty of p ury that) am ense u r v' ons of Chapter commen - (hereby affirm under penalty of perjury one of the following decl
'Section 7000) iv' Tori 3 o e Business an ro io I ,and my Lice orce and effect. I have and will maintain a certificate of con o self -insure for workers' compensate , as provided _
Li' ns Li a No.* - for by Section 3700 of the Labo e, for the performance of the work for which t s permit is _
/ issued. -
ontrac. .I have and will maintain r ers' compensation insurance, asrequiredby Section,370 of the Labor
Code, for the pe mance of the work for which this permit is issued.- My work ' compensation,
�1..�exempt
ER-BUILDERDECLARATION' insurance c er and policy numberare: I hereby affirm u pe y from the Contractor's State License Law for the : _ Carrier B Policy Numb - - - - -- - - - - - - -
following reason (Sec. 7031.5, siness and Professions Code: Any city or county that requires a permit to _ ertify at, in theperformance of the work - -
construct, alter, improve, dem sh, or repair any structure, prior to its issuance, also requires the applicant for the per in a ome ject.to compensation laws of California,
.permit to file a signed statement that he or she is licensed pursuant to theprovisions of the Contractor's State a that, if I should become s ect to ers' compensation provisions of Section _
License Law (Chapter 9 (commencing with Section 7000) of Division 3 o the Business and Professions Code) or Qp of the Labor Co e, I shall -f ' h y with those provisions..
that he or she is exempt therefrom and the basis for. the alleged exemption., Any violation of Section 7031.5 byd
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).: a i Applicant:✓ -
.(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure isnot intended or offered for sale (Sec: 7044, Business and Professions Code: The W NIN FAILURE TO SECURE WO ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL - -
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, S BJE AN EMPLOYER TO CRIM AL 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 OL 0100,000)`. IN ADDITI N 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. ECTION 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 _ 1 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 coniractor(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 is his application,
1 _ 1 I am exempt under Sec. B.&P.C. for this reason the owner, and the applicant, each agrees to, -and shall def emnify and hold harmte a City
of La Quinta, its officers, agents and employees fo act or omission related to the work bein - -
performed under or following issuance of th' rmit.
Date: Owner. - - 2: Any permit issued as a result of this ap ' ation becomes null and void if work is not c menced -
within 180 days from date of issuanc of such permit, or c on of wo 0 s will subject
CONSTRUCTION LENDING AGENCY �� per it to can anon. - -
I hereby affirm under penalty of perjury that there is 6 construction lending agency for the performance of the I certify that I e read application an Fate that th a ' is ,e t. I ee to comply with all - \
work for which this permit is issued (Sec. 3097, Civ. C.). - city and c u ordina s a aws relating to buil 'n on, a
- ofth' t en u n the above-mentioned prop n on pose -
Lender's Name: -
• Date' ature (Applicant or Agen
_. Lender's Address: ..
LQPERMIT
Application Number 05-00003391'
• Permit WALL/FENCE
PERMIT
_
Additional desc .
Permit Fee - 43.00
Plan Check
Fee
00
Issue.Date
Valuation
1825
Expiration Date 1/30/06
Qty. Unit Charge 'Per
Extension.
BASE
FEE
15.00
14.00 2.0000 HND' BLDG
501-2;000
28.00-
-------------------- -------------------------
Special Notes and Comments
------- ---------------
------------
`
73 L.F. 6'' GARDEN WALL & 6 L.F.
21
_ GARDEN WALL, ORCO SYSTEM.
Fee summary Charged,
Paid' Credited
Due
- - ---
Permit Fee Total 43.00
--- - - - - ------ - - -
.00
- - -
.00,
43.00
Plan.Check Total .00.
.00
.00
.00
Grand Total 43.00
.,00., ;:.00
43.00
LQPERNIIT