05-3397 (BLCK)f
P1P:0. BOX 1504 ` VOICE (760) 77.7-7012
1V 78-495 CAL LE TAMPICO AUG � � J1(Q�nn FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 UILDING 2r. SART ARTMENT INSPECTIONS (760) 777-7153
COTrTL E IT
___ FI CE DEPT. Date: 8/03/05
Application Number: 05-0000339 Owner:
Property Address: 57395 VIA VISTA PUERTA AZUL PARTNERS
APN: 762-240-003-30' -300962 17700 SW UPPER BOONES FERRY RD
Application description: WALL/FENCE' SUITE 100
Property Zoning: MEDIUM DENSITY RES PORTLAND, OR 97224
Application valuation: 1573
Contractor:
Applicant: Architect or Engineer: ,' DAVIS/REED CONSTRUCTION INC
WCC: STATE FUND
WC: WC298892005 06/30/06
CSLB: 813480 10/31/06
ENSED ACTO N - .WORKER'S COMPENSATION DECLARATION -
I here affirm n er penal peri that I am li ns under comm wit I hereby affirm under penalty of perjury one of the following declarations:
' n 700 of Divi ' 3 of th usiness and o nd License is ' orce and effect. , - _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
se C a c� N for by Section 3700 of the Labor Code, for the performance of the work for which this permit is + ,.
• ._�. -y._ ..,-._. _...issued.
I .Contractor. - - I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
- Code, for the performance of the work for which this permit is issued. My workers' compensation
OW R•BUILDER DECLARATION insurance rrier and policy number are:
[.her by affirm under penalty of peri that I am exempt from the Contractor's State License Law for the Carrier B Polic ber - - - - - - - - - - - - - - -
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to , - _ certify t , in the performance o i is -issue II not employ any -
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the pers n any man s to b e subject to the ers' compensati laws of California, -
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State - an greet should be subject to the - ers' compensa ' provisions of Section
license Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or - 0 e Labor Code, I II hwith comp withthat 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).:
(_) 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 W RNIN FAILURE TO SEC E WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL .�
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, BJEC AN EMPLOYER T 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 OLL - S ($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
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 contractsfor 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 ny permit issued as a resu application,
1 _ 1 I am exempt under Seca B.&P.C. for this reason the owner, and the applicant, ea es to, and shall defend, indemnify and hold harmless ity
- of La Quinti, its
officers, a s and employees for any act or omission related to the work being
' performed under or follo ng issuance of this permit.
Date: Owner: .2. Any permit issued a5y res of this application becom 05 and void if work is not commenced
within 180 days m date o nce of such pe cessation of work for 180 days will sub' t
r CONSTRUCTION LENDING AGENCY per it to cant atian.
I hereby affirm under penalty of perjury that there is a construction lending agency theperformanceof the -I certify th I ve read is applicati d state that t I agree to y with all
work for which this permit is issued (Sec. 3097, Civ. C.). - - _ city or ina es and a laws relating t ild' ction, a eby a ntatives
• _ of thi nt a above-mentio op in ectio r es.
Lender's Name: /
_Da Signature (Applicant or I): r -
Lender's Address:
LQPERMIT
Application Number 05-00003397
Permit .. . . . . . WALL/FENCE PERMIT
t
Additional desc .
Permit.Fee 37.,00 Plan Check
Fee
.00
Issue Date "' Valuation.
1573
Expiration Date 1/30/06'
Qty Unit Charge Per
Extension
BASE FEE
15.00 "
1.1.00 2.0000 HND BLDG 501-2,000
22:00,
--------------------------------
Special Notes and Comments
7_1
------------
45.L.F. 6' GARDEN 'WALL, 28 L. V. 4'
GARDEN`..WALL & 6 . L.F. 21 GARDEN WAL_ L ,
ORCO SYSTEM.
Fee summary. Charged, 'Paid Credited,
Due
Permit Fee Total .. 37.00 .00 -.00
37.00,
Plan Check''Total 00 .00 ..
.00
.010
-Grand Total 37.00 .00
.00 :
37.00
LQPERMIT