05-4392 (BLCK)P.O. BOX 1504 �^�_ R VOICE 760 777-7012
78-495 CALLE TAMPICO FAX (760)777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
- - �9V2
Date: 9/29/05
Application Number. 05- Owner:Property Address: �574PUERTA AZUL PARTNERS
APN: 762-240-003-70 .300962- 17700 SW UPPER BOONES FERRY RD
Application description: WALL/FENCE SUITE 100
Property Zoning: MEDIUM DENSITY RES PORTLAND, OR 97224
Application valuation: 2127
Contractor:
Applicant: Architect or Engineer: 1 ,2005 DAVIS/REED CONSTRUCTION INC r
nc 1'1 169 SAXONY ROAD, SUITE 105'
ENCINITAS, CA 920'24
®p�QUIR�TB� s
ti CE0EP'T.. (760)634-2350
/ Lic. No.: 813480
,�.._ _
�- .LICENSED RACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
• I hereby affirm u er naltf perj y that) a an d under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of'the following declarations:
Section 0Q0 f Div Sion of th Si re nd ssionaIs Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Li a la License No.:' 813480 for by Section 3700 of the tabor Code, for th ormance of the work for which this permit is _
- - issued.
a '': "Contract _ I have and will maintain workers' compe tion ins ante, as required by Section 3700 of the Labor
T Code, for the performance of the w for whi this permit is issued. My workers'. compensation
• OWNER -BUILDER DECLARATION insurance carrier and policy num r. are: '
hereby ffirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier S TE FUND Policy Nu er WC298892005 ,
f followin reas n (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to +Ri$100,000).
ify that• n the performan the wor or which this permit is issued, I shall not employ any ,
construct, alt ,improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for therso any manner so come "act to the wor enation la�ots of California, -
permit to file signed statement that he or she is licensed pursuant to the provisions of the Contractor's State gree that, if I sho a su act to ers' compensation provisions of Section -
License Law Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code), or700 of the Labor Cc e, f comply with those provisions. _
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).: scant: -
(. 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 - ' - RE TO SECURE - KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
., Contractors' State License Law does not apply to an owner of property who builds or improves thereon, - SUB ECPLOYER TO CRIM AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
ti and who does the work himself or herself through his or her own employees, provided that the - 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 • F 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.). - - - a. APPLICANT ACKNOWLEDGEMENT
(_ 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 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 nd, 'ndemnify and hold harmless the City
of La Quinta, its officers, agents and employees fo y act or mission related to the work being
performed der or following issuanceof this p , it.
Date: Owner: 2. Any perms issued as a result of this app)' a ' n becomes n and void if work is not commenced
• - witp'n 1 days from -date of i uan uch permit, cessation of work for 180 days will subject
- - CONSTRUCTION LENDING AGENCY pe ryit cannee �tlo -
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I eve eat`this application a d st t t abov information is agree to comply with all
.work for which this permit is issued (Sec. 3097, Civ. C.). city and cou inances and state la rel ng o ildin on , and hereby authorize representatives
- of this c Upon abov en ' ne p e nspection purposes.
Lender's Name:'
nature (App an
Lender's Address:
LQPERMIT
f
y1
Application Number . . . . . 05-00004392•
Permit. . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . . 54.00
Plan Check
Fee
.00
Issue Date_
Valuation
2127
Expiration Date 3/28/06
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
---------------
71 L.F. 61-& 8•L.F. 2' & 22 L.F.
41BLOCK WALLS, ALL-ORCO SYSTEM
Fee summaryCharged. "
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
LQPERMTT