05-4389 (BLCK)P.O.-BOX 1504 �^� - VOICE 760 777-7012
78-495 CALLE TAMPICO 'FAX(760)777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 _
r: BUILDING PERMIT
Date: 9/29/05
Application Number: 05-000.04389 Owner: `
Property Address: 57430 VIA VISTA ® PUERTA AZUL PARTNERS
APN: 762-240-003-68 -300962 ® 17700, SW UPPER BOONES FERRY RD
Application description: WALL/FENCE SUITE 100
Property, Zoning: MEDIUM DENSITY RES. RTLAND, OR 97224
Application valuation. 2875 R 9R
Qontractor:,
Applicants Architect or Engineer: - DAVIS/REED CONSTRUCTION INC -
169 SAXONY ROAD, SUITE 105
ENCINITAS, CA 92024
4. (760)634-2350.
1 Lib. No.: 813480
CE SE NTRACTOR S DECLARATION WORKER'S COMPENSATION DECLARATION
_ I hereby a 'M d penalty perj h t I icensedunder provisions of Chapter.9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Secti n 7 0) o Division 3 f the an Professionals Code, and my License is in full force and effect. e 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
• Licens ass, License No.: 813480 - - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is -
issued.
- ate: �d tor: - _I ve and will maintai orkers' compensation insurance, as required by Section 3700 of the Labor, .
/ Code, for the pH orma e o e work for which this permit is issued: My workers' compensation
OWNER -BUILDER DECLARATION insurance c ier and olicy num r are:
hereby' ffirm under penalty of p r ry that I am exempt from the Contractor's State License Law for the Carrier A E F P 'cy Number WC298892005 - -
• following reas n (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to , _ certif that, in the erformance of the work for which this permit is issued, I shall .not employ any
- r constru lalte , improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any m nne s as to beco subject to the workers' compensation laws of California,
permit to file signed statement that he or she.is licensed pursuant to the provisions of the Contractor's State _ d agree that, Is d be me su act to the workers' compensation provisions of Section
License Law (hapter 9 (commencing with Section 7000) of Division 3. of the Business and Professions Code) or t 700 of the La r s 11 forth ith comply,wi hose 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 than five hundred dollars (S5001.: � e icant:�
�. - -
- (_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and -1 .. "
the structure. is not intended or offered for sale (Sec. 7044, Business and Professions Code: The - WA NTNG: FAILURE TO SECUR RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO 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 " I DOLLARS ($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, 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,
(_) I am exempt under Sec. , B.&P.C. for this reason t the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents a mp o for any act or omission related to the work being
- - - performed under or following i ante of this pe it. '
Date: Owner: _ 2. Any perm' issued as a re sul of this application be mes null and void if work is of commenced -
wi 'n 7 0 days from d issua ce such per it, or cessation of or 180 days will subject
CONSTRUCTION LENDING AGENCY - - p mil t cancellati
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the _ I certify that I be ead th' ppli tion and st e e abo atio I agree to comply with all
work. for which this permit is issued (Sec: 3097, Civ. C.1. - • city and c y of na sand st t laws rel m' construction, and hereby authorize representatives
Of this co t upon th e e for inspection purposes. -
Lender's Name: - -
A nature (Applicant or A 0:
Lender's Address:
* PERMIT
Application Number . . . 05-00004389
Permit WALL/FENCE PERMIT.
Additional desc .
Permit Fee . . . . 54.00 Plan Check_
Fee
Issue Date Valuation
2875
Expiration Date ." 3/28/06
Qty Unit Charge Per
-Extension
BASE FEE
.45.0.0 , .
1.00 9.0000 THOU BLDG 2,001-25,000
9.00
- Special Notes and Comments
115 L.F..6' BLOCK WALL, ORCO SYSTEM
Fee summary Charged 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
a.
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