05-3401 (BLCK)D
•P, O. BOX 1504 I
VOICE (760) 777-7012
78T+95 CALLE TAMPICO�
Q(f(y.
FAX (760) 777-7011
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LA QUINTA; CALIFORNIA 92253BU S
Y DEPARTMENT INSPECTIONS (760) 777-7153
LD
E
PERMIT .
Date: 8/03/05-
Application Number. 05-00003401•
Owner:`
Property Address: 57419 VIA VISTA
PUERTA, AZUL PARTNERS
APN: 762-240-003-34 -300962-
17700 SW -UPPER BOONES.FERRY RD
Application description:' WALL/FENCE
SUITE 100
Property Zoning: MEDIUM DENSITY RES- ;.
PORTLAND,, OR 917224
'Application valuation: 2125_
Contractor: R
Applicant: Architect or.Engineer.
DAVIS/REED CONSTRUCTION INC
• WCC,: STATE FUND,•"
i
WC: WC298892005 06/30/06
• )>. /�
C_SLB: 813480 10/31/06
'LICENSED C R'S DECLARATION -.
•
- . WORKER'S COMPENSATION DECLARATION
- - I hereby affir nder p ty of perjury that I tens er provisions of Chapter 9 nencing with
I hereby affirm under penalty of perjury one of the following declarations:
Sectio 0 1 of Di ' ' n 3 of t and Pro nals Code, and my Lice in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
- Lice s ss: ; Licens No.:
- for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
' ,� ✓� ontr tor: - •j'
issued.
I have and will maintain w mpensation insurance, as require 'on 3700 of the Labor
-
Code, for th rmance of the work for which this permit is issued. My wor ' ompensation `.-
- OWNER -BUILDER DECLARATION •
insur rrier and policy number are:
ereby firm under penalty of perjury that I am exempt from the Contractor's State License Law for the . ,;
Carrier -B' Policy Numb r ' - - - - - - - - - - - - - - -
followin reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to - - •,
- certify `, in the performance of the wor or which this peris ' ,I shall not employ a
constr ; alter, improve; demolish, or repair any structure, prior to its issuance, also requires the. applicant for the
- perso manner so as to beco subject to the worker ' mpensation laws of C nia,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State -
.and ee that, i -
. License Law (Chapter 9 (commencing with Section 7000) of Division -3 of the Business and Professions Code) or -
i - e or Code, I s hwith comp) those provisi -
" 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).:
pplicanee -" -
- ( ) 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-
ARNIN FAILURE TO SECUR KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL _
Contractors' State License Law does not apply to an owner of property who builds or improves thereon;
SUBJEC AN EMPLOYER TO NAL 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, 1$100,000). IN. ITION 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 notbuildor
-
improve for the purpose of sale.). - -
APPLICANT ACKNOWLEDGEMENT
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 f this application, '
1 _ 1.1 am exempt under Sec. , B.&P.C. for this reason -
- the owner, and the applicant rees to, and shall defend, indemnify and hold harm a City
. -
- of La Quinta,its offi , gents and employees for any act or omission related tothe work being -
' - - •
performed un or following issuance of this permit. '
Date: Owner: -
2. Any permit i ued as a result of �' is'applica - beco nu d void if work is not commenced
• -
wit 180 da f issuance it cessation o ork for 180 days will subject '
' CONSTRUCTION LENDING AGENCY
- p it to c ellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the.performance of the
I certify tha have re his applicat' t e ve info ion is correct. m ly with all
work for which this permit is issued (Sec. 3097, Civ. C.).
city a c my ord' nce ate law I ing co
• - '.
of t my t to on the above- a inspection purposes.
Lender's Name:.
- -
" • '
D ignature•IApp-icant or Agentl:
Lender's Address:
LQPERASIT • -
.
Application Number ., .. . . 05-00003401
-
Permit- . . . WALL/FENCE PERMIT
Additional desc
Permit Fee 54.00
Plan Check
Fee
.00
Issue Date . . .
Valuation
2125
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
----.--------
------
---------------
85 L.F. 6' GARDEN WALL, ORCO SYSTEM.
Fee summary ChargedPaid
-------------------
Credited
Due
Permit Fee Total 54.00
.00
..00
54.00
Plan Check.Total 00
:00,
0.0
00
Grand -.Total 54.00
.00.
.00-
54.0.0
o
LQPERMIT