05-3402 (BLCK)4 Qs
�P..O. BOX 1504 ' VOICE (760) 7773M
T� 78495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 - I IL & SAFETY DEPARTMENT INSPECTIONS (760) 777-7151-
LD RMIT +
Date: 8/03/05-
Application Number: 0500003402 AUG Owner:
Property Address: - 57425 VIA VISTA Ui;7 3 99 PUERTA AZUL PARTNERS
APN: .762-240-003-35 -300962= Coo° 17700 SW UPPER,BOONES FERRY RD
Application description: WALL/'FENCE c/�'Qp SUITE 100
Property Zoning: MEDIUM DENSITY RES_/�AA1CU/�T� PORTLAND, OR 97224 `
Application valuation: 2323
Contractor:
Applicant: _ Architect or Engineer: DAVIS/REED CONSTRUCTION INC
WCC: STATE FUND
WC: WC298892005' 06/30/06.
CSLB: '813480 10/31/06
-
NSE 0 ECLARATION .. - WORKER'S COMPENSATION DECLARATION "
- 'I hereby irm under nalt , f perj I a e nd rovisions of Cha ter I hereby affirm under penalty of perjury one of the following declarations:
Se 000) of D' ' io of the si s fe i y icens orce and effect.. I have and will maintain a certificate of consent to self-insure for workers' compensation, as provided .
Cla : License No ' _ - "-for by Section 3700 of the labor Code, for the performance of the work for which this permit is -
t1 issued. "
a :on - - I have and will maintain workers' compensation insur 00 of the Labor
- C , for the pe rmance of the war is this permit isissued. My workers enation
"OWNER-BUILDER DECLARATION - `- ' - urance•car ' r_and_policy_ n are: -
I here ffirm under penalty of perjury that I am exempt from the Contractor's State License Law for the ' : Carrier B P61icy'Numbe— -----------
folio
- _-------_folio ng reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to 6ertify th - , in the ormance of th hi his permit' sued, I shally6t employ any,
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the. • perso in anya o•the worker .compensation I s of California,
- permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State- an gre at, if I should become a war er r isions of Section '
License Law .(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or he Labor Code, I.shal it Iy with tho provisio
that he or she is exempt-therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by -�' i
any applicant for a permit subjects the applicant to civil penalty of not more than five hundred dollars ($500).:.Applicant: -
O 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 - ARNING: FAILURE TO SECURE WORKERS' 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 - 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 -
i _ 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 contracts for the projects with a contractors) 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 - - the owner, and the applicant, each agrees to, and shall defend, indem a9-geld-kartrtfeas•iti ity
of La Quinta, its officers, agents and employees for'any a fission related to the work being -
- - performed under or following issuance of this per
Date: - Owner: - -2. Any perm't issued as a result of this applicati ecomes null and'void if work is not commenced
within 0 days am date of issuance such per 'tom ssation of work for 180 days will subject
CONSTRUCTION LENDING AGENCY per ' to cancel ion. _
I hereby affirm under penalty of perjury that there is a'construction lending agency for the performance of the - I certify t I ve read t i applicati sta that t bo v f a' is corr 1 agree to comply wit
work for which this permit is issued (Sec. 3097, Civ. C.). - city an c • yor ina s ate laws relatin o ildin u n, an eby authorize re atives
j - - of this up the above-mentioned op n ases. -
;Lender's Name:
• - - D ature (Applicant or entl'
- Lender's Address: ' . - ,
LQPERMIT " -
!� Application Number 05-00003402
Permit . .WALL/FENCE PERMIT
Additional 'desc
Permit Fee 54.00
Plan Check Fee
00
Issue Date
Valuation
2323.
Expiration Date 1/30/06
Qty Unit Charge Per
Extension
BASE FEE
45.00.:
9.0000 THOU BLDG 2,001-25,000
9.00
-------------------•--
Special Notes and Comments
------------------
---------------
75 L.F. 6' GARDEN WALL, 28 L.F. 4'
GARDEN WALL & 6 L.F. 2' GARDEN WALL,
ORCO SYSTEM.
- Fee summary Charged PaidCredited
'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
LQPERMIT
..