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05-3395 (BLCK)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 ($500).: , (_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, - and who does the work himself or herself through his or herown employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of provingthat he or she did not build or improve for the purpose of sale.)'... , 'I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.l. ' (_) • I am exempt under Sec. B.&P.C. for this reason. Date: Owner: ' CONSTRUCTION LENDING AGENCY - I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the - work for which this permit is issued (Sec. 3097, Civ. C.). -. Lender's Name: Lender's Address: LQPERAIIT .ARNIN�•FAILURE TO SECURE R ' COMPENSATIO�J COVERAGE IS UNLAWFUL, AND SHALL BJEC AN EMPLOYER TO C I PENALTIES.AND CIVIL FINES UP TO ONE HUNDRED THOUSAND OLLARS 1$_100,0001. IN A N TO THE ST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION.3706 OF THE LA CODE; INTEREST, AND ATTORNEY'S FEES. 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 pu I .i u f this application, ' the owner, and the applicant, a es to, and shall defend, indemnify -and hold harm he City. , - of La Quinta, its office nts and employees for any act or omission related to the work bei performed and ollowing issuance of this permit. \ 2. Any er _ suep4s a result of this application beco _. in 18 e o such permit ce ation or or 180 days will subje t ermit to cellation. -� - I certify t I have ad this a ion and state that the ve ' rmati is rrect: I agree to comply w' all it c my inances nd state laws relating to bu' n trio d hereby authorize represe fives nt a ter the above-mentioned pro i urposes. - at ignature (Applicant or A •�� BOX 1504..' VOICE (760) 777-7012 - 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA CALIFORNIA 92253 ' BUAbDING& SAFET PARTMENT INSPECTIONS (760) 777-7153 W-1 6 AG MIT �CITY OF QUI Date: 8/03/05 APPlication Number. 05� 00003395 l F1N(;��' Owner: Property Address: 57383 VIA -VISTA °i PUERTA AZUL PARTNERS APN: 762-240-003-28 -300962- 17700 SW UPPER BOONES FERRY RD ` Application description: WALL/FENCE SUITE 100 ' -f Property Zoning: MEDIUM DENSITY RES `PORTLAND, OR '97224 Application valuation:. 2750 Contractor: '. . Applicant: Architect or Engineer: DAVIS/REED :CONSTRUCTION INC WCC: STATE. FUND WC: WC298892005 06/30/06 CSLB: 813480 10/31/06 --------- ------- ------- -- ---- ------------------.----------------------- • t LICENSED CO O RAT --------------------- �. WORKER'S COMPENSATION DECLARATION - Ifiere affirm nder penal eriury that I am lic ed d r ' s of apter 9 (commencing with y.afflrm-under penalty of perjury one of the following declarations: - - i - n7 0 of Di ' 3 the Business and fe on ' nd License' dere ec . - I have and will maintain a certificate of.consent to self -insure for workers''compensation, as provided i nse I -; for by Section 3700 of the Labor Code, for the performance of the work for which this permit is - - a " ' Contra r. _ issued. I have and will maintain workers' compensation ins 0 of the Labor • - _ Code, for the performance of theichthis permit is issued. My workers' c ensation ' - NER-BUILDER DECLARATION "- - insurance rrier and polic er are: - I he by affirm under penalty of pe ' "that I am exempt from the Contractor's State License Law for the - Carrier. -B Polic r - - - - - - - f- - - _ - - - fol wing reason (Sec. 7031.5, Business and Professions Code: Any city or county'that requires a permit to .; _ .certify , in Performa a work for whi is rmit is i ed, I shall not employ any . construct, alter, improve, demolish, or repair any structure', prior to its issuance, also requires the applicant for the pers ny ma o as to become subje th orker ' o " nation la of Californ' - - permit to file a signed statement that. he or she is licensed pursuant to the provisions of the Contractor's State. yaljJ 22 a ree , d I should become subj. •t - orker '- ompensation ns of S on. License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or - _ _ f2 a Labor Code .- 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 ($500).: , (_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, - and who does the work himself or herself through his or herown employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of provingthat he or she did not build or improve for the purpose of sale.)'... , 'I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.l. ' (_) • I am exempt under Sec. B.&P.C. for this reason. Date: Owner: ' CONSTRUCTION LENDING AGENCY - I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the - work for which this permit is issued (Sec. 3097, Civ. C.). -. Lender's Name: Lender's Address: LQPERAIIT .ARNIN�•FAILURE TO SECURE R ' COMPENSATIO�J COVERAGE IS UNLAWFUL, AND SHALL BJEC AN EMPLOYER TO C I PENALTIES.AND CIVIL FINES UP TO ONE HUNDRED THOUSAND OLLARS 1$_100,0001. IN A N TO THE ST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION.3706 OF THE LA CODE; INTEREST, AND ATTORNEY'S FEES. 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 pu I .i u f this application, ' the owner, and the applicant, a es to, and shall defend, indemnify -and hold harm he City. , - of La Quinta, its office nts and employees for any act or omission related to the work bei performed and ollowing issuance of this permit. \ 2. Any er _ suep4s a result of this application beco _. in 18 e o such permit ce ation or or 180 days will subje t ermit to cellation. -� - I certify t I have ad this a ion and state that the ve ' rmati is rrect: I agree to comply w' all it c my inances nd state laws relating to bu' n trio d hereby authorize represe fives nt a ter the above-mentioned pro i urposes. - at ignature (Applicant or A :.A Application.Number 05-00003395' Permit WALL/FENCE PERMIT Additional desc . -. Permit -•Fee _ 54.00 Plan Check Fee .00 Issue Date - .. Valuation 2750 _ 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 --------- ------ --------------- 110 L.F. 6GARDEN WALL, ORCO SYSTEM. Fee summary '.Charged 'Paid Credited Due Permit Fee Total 54.00 ---------- .00 I ---------- .00: 54 00 Plan Check Total .00 .00 .00. .00 Grand Total 54.00 :00 -,0'0 54.00 LQPERMIT - - - - - -