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05-3399 (BLCK),.P P:6 -. 'BOX 1504, ' VOICE (760) 777-7012- 78495 CALLE TAMPICO D d FAX (760) 777 -7011 - LA QUINTA, CALIFORNIA 92253 B DEPARTMENT INSPECTIONS (760) 777-7153 OBZUI,DI ERMIT AUG 3 UU Date: 8/03/05 Application Number: 05-0000339,9 Owner: ' Property Address: 57407• VIA VISTA CSN®F•tAQONTA PUERTA AZUL PARTNERS APN: 762-240-003-32 -300962= CEDEPT. 17700 SW UPPER BOONES FERRY RD Application description: WALL/FENCE SUITE 100 Property Zoning: MEDIUM DENSITY RES PORTLAND, OR 97224 { Application valuation 875 ' ,. Contractor: , Applicant: Architect or Engineer: DAVIS/REED CONSTRUCTION INC WCC; STATE FUND: r i. WC: WC298892005- 06/30/06 CSLB • 813480 '10/3 l, /06 4� ` CENSED - T ACTOR' CrI N - `., -', r . WORKER'S COMPENSATION DECLARATION - hereby,off' under tyof peri hat I am I' ns under pr inions of C pier 9 mmencing with I hereby affirm under penalty of perjury one of the fallowing declarations: Section 7) of Di i n 3 of usiness an rof sionals C e, and m tens in full - _ l -have and will maintain a. certificate of consent to self -insure for workers' compensation, as provided .` Licen ass: - Li C. No.: for by Section 3700 of the Labor Code, for the performance of the work for which this permit is - issued. Dat J ontra or: I have and will maintain workers' compensation in ection 3700 of the Labor,; , Code for the performance of or isor ern nsap hew My w k ' compe tion WNER-BUILDER DECLARATIONinsurance carrier and policy nu _ are: I reby irm under penalty of perju that I am exempt from the Contractor's State License Law for the - Carrier 13 Policy Number- - • ` f lowing reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to I certify that,in he pe mance of the work for which this permit is issued I shall not employ any - + - construct, alter, improve,'demolish, or repair any structure; prior to its issuance, also requires the applicant. for the pers in any. ner so as to bec a subject to the workers' compen tion 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 gree t " ouId be co bjeZcplyl-"ethose compens n provisions of Section License Law, (Chapter 9 (commencing with Section 7000) of, Division 3'of the Business and Professions Code) or Do b Code, s f itions..that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant foga permit subjects the applicant to a civil penalty of not,more than five hundred dollars ($500).: - - Applican • , 1 7 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 Coded The W NIN FAILURE TO SE KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL ; Contractors' State License Law does not apply to an owner of property who builds or improves thereon, BJE AN EMPLOYER TO RIMINAL 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 DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN. .improvements are not intended or offered for sale. ff, 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 for the purpose of sale.) • - - - APPLICANT ACKNOWLEDGEMENT 1 _ 1 1, as owner of the property, am exclusively contracting, with, licensed contractors to construct the project ISec. 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. _ -1. , 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 result of this application, - ( _ 1 I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, .its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. - • , Date. Owner: :2. Any permit issued Wa result of this application beco voi i wor is no =ced .. within 0 day rom date of issuance o permit, or c�Fcorre r 1.80 days wil - ject f CONSTRUCTION LENDING AGENCY per to can lation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify _that I reafl• is application at the abov orgree to comply wit all. work for which this permit is issued (Sec. 3097, Civ. C.). city and un or ces ws relating to buildi c u orize representa ' es ,of thi n p the above- ed rope f' n ur 4 Lender's Name: Da ature (Applicant or Agent Lender's Address: � � � _ � - LQPERAiIT'. „= Application Number . . . . 05-00003399 ' Permit . . . . ... WALL/FENCE PERMIT Additional desc . Permit Fee .23.00. Plan Check Fee 00 Issue Date Valuation 875 Expiration Date 1/30/06 Qty Unit Charge Per Extension BASE FEE 15.00 4.00 2.0000 HND BLDG 501-2,,000. 8.00 -- Special Notes and Comments - -- - - -- --- - - - - -- - 35 L.F. 6”' GARDEN WALL, ORCO SYSTEM Feesummary' Charged. Paid ..-Credited Due Permit Fee Total', 23:00.. .00 .00 23.00 Plan Check Total .00 00'.:r :00` .00 Grand Total 23.00.• :: .00 00 23..00 LQPERAIIT ' .