Loading...
05-4391 (BLCK)T4ztt 4 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 BUILDING PERMIT Date: 9/29/05 Application Number: 05`'00.004391' f - Owner. ' Property Address: 57440 VIA VISTA PUERTA AZUL PARTNERS ''APN: 762-240-003-69 -300962-. 17700 SW UPPER BOONES FERRY RD Application description: WALL/FENCE SUITE 100 Property Zoning: MEDIUM DENSITY RES o PORTLAND, OR 97224 Application valuation: 1802 f i d Contractor: �= . •Applicant: - Architect or Engineer DAVIS/REED CONSTRUCTION INC _ SAXONY ROAD, . SUITE 105 N`~_ Ra.. " r ENCINITAS, CA 92024 (760)634-'2350 }, 4 - C� � 'LlC.w No 813480 - ----------- - - - - -- - - - - ------ - - - - -- ----------- - -- - - -' - - -- -------------------- " C N ED CONTRA OR'S DECLARAT + * r, " . r WORKER'S COMPENSATION DECLARATION - _% - - - - - . 1hereb aff m un r penalty of perjury, at I li n d ur' r provision apter9 (commencing with rc' ,.: - I hereby affirm under penalty of perjury one of the following declarations: Sectio 70 0) 0 ivision 3 of the Bus' ess siona Code 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 can s:. - e No.: 813480,. y for by Section 3700 of the Labor Code, for the performance of the work for which this permit is ' QQ t issued: +Datp� 'Contractor: r I have andwill inaintainworkers' compen n insuran e, as required by Section 3700:of the Labor a Code, for the performance of the rk for which t I permit is issued. M_ y workers' compensation NER,BUILDER-DECLARATION - _ in urance carrier and policy nu er are: - - I hereb a irm under penalty o perjury tha l a exempt from the Contractor's State License Law for the . - - Carrier S AT FUND • - Policy Number C2 988920 O S - - follow g r ason (Sec. 7031.5, Business a Professions. Code: Any city or county that requires a permit to. > ;�" d rtify , in the perfor nce a work for �chthis permit is ' ,-F shall not employ any, construct,. alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the - - pe on in any "manner o as c me subje ers' compensation laws of California, ' \' permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State `. `..� - ,/ agree. that if I s ould o the workers' compensation provisions of Section ' License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or '. /p _37 0 of the [Co forth comply with those provisions. 1 r that he or she is exempt therefrom and the basis for the alleged exemption. Any. violation of Section 7031.5 by. an applicant for permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).: a Applicant: - • . '.y. Y PP P I PP P ,..� Pp _ (_) 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 ARN G: FAILURE TO SECUR RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL - - t Contractors' State License Law does not apply to an owner of property who builds or improves thereon, "' UBJ CT AN EMPLOYER TO CR ANAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND r . and who does the work himself or herself through his or her own'employees, provided that the DOLLARS (5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN' ' .r + 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 ha_ ve'the burden of proving that he or she did not build or ,- + + - 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 permit subject to the . _ 9 P 1 Pp , Y 9 Y P _ 1 .,` 7044, BusinessandProfessions Code: The Contractors' State License Law does not apply to an owner of _ _conditions and restrictions set forth an this application. _ property who builds or improves thereon,, and who contracts for the projects with a contractods) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for . r,.•. - .pursuant to the Contractors' State License Law.). whose benefit work is performed under or p n permit issued as a result of this application, (_ 1 I am exempt under Seca , B.&P.C. for this reason the owner, and the applicant, each agr to, and shall def d, indemnify and hold harmless the City , _ - of La Quinta, its officers, agents employees for any act r omission related to the work being ' - - - performed under following ' uance of is permit. Date: Owner: " - - 2. Any permit issued as a res of this app' tion becomes n II and void i rk'i not of commenced - ithin 1 0 days from 'of issuanc s h per o c of work for 180 days will subjec( CONSTRUCTION LENDING AGENCY - - _ ermit cancellatio I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of. the - I certify tha have ead this cation and sta ov ormation is. correct. I agree to comply with all . work for -which this permit is issued (Sec'3097, Civ. C.). - - city and my or uance n state laws rel o uil ng ruction, and hereby authorize representatives y of thi ty to ter upon ea bov - i p p y f ' spection purposes. .Lender's Name: - - - ._ �. a nature (APPlicant �. y Lender's Address: - ,: - LQPERMIT f .-4 ✓ Application Number 05-00004391 - Permit . . WALL/FENCE PERMIT Additional•desc . Permit Fee 43.00 Plan Check Fee .00 Issue Date Valuation 1802,. Expiration Date 3/28/06 ` Qty Unit Charge Per Extension BASE FEE. 15.00 14.00 2.0000 HIND BLDG 501-2,000 28.00 ---------------------:-------------------------------------------- Special Notes and Comments 58 L.F. 6! & 14 L.F. 2' & 22 L.F. 4' BLOCK WALLS, ALL ORCO SYSTEM Fee summary Charged Paid Credited Due --------- ---------- Permit Fee Total 43.0000 ---------- --------- 00 43:00 Plan Check Total .00.00 00 00 Grand Total 43.00 .00 .00 43.00`, LQPERMIT - .