06-0268 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA, QUINTA, CALIFORNIA 92253
Application Number:
06-00000268
Property Address:
77186 CASA DEL
APN:
773 -360 -005 -
Application, description:
WALL/'FENCE
Property Zoning:
MEDIUM DENSITY
Application valuation:
2500
Applicant:
I
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
SOL
- - e
RES
JAN 18 2006
Architect or
wle(,l
-------------------
LICENSED CONTRACTOR'S DECLARATION
Owner:
ANSCHEL HAROLD
OF I.A®UKrA Contractor:
NCR t HBA DEVELOPMENT
P.O. BOX 605
HERMOSA BEACH, CA 90;251
(310.)318-1580
Lie. No.: 654540
I hereby affirm under penalty of perjury that I am lictrised under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busirsa d Pr. fessionals Code, and my License is in full force and affect.
License Class: S License No.: 6545'40
Date: Con ctor: ry
OWNER -BUILDER DECLARATION
Ihereby affirm under penalty of perjury that l am exempt from the Contractor's State Lioense.Law for the
following reason, (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter; improve; demolish, or repair any.structure, prior to its issuance, also requires.the applicant) for the
permit to file a signed statement thabhe or she.is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000).of.Division 3 of the:Businew..and Professions Code) or
that he or she is exempt therefrom end the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant fora permit subjects the'applicant.to a civil penalty of not more than five hundred dollars (9600).:
(_ 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
Contractors' State License Law does not apply to an owner of -property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided'that the
improvements are,not Intended or offered for sale. If, however; the building or improvement is soldwithin
one year of completion, the owner -builder will havethe burden of proving that he or she did not build or
improve for the purpose of sale.).
(._ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects .with a contractor(s) licensed_
pursuant to the Contractors' State License Law.).
1 _ 1 1 am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDINO'AGENCy
I hereby affirm under penalty of perjury that.therwis a construction lending agency for the performance of the
work for which this permit.is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's. Address:
r x r
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/18/06
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one :of'the following declarations:
Lhave:and will maintain a cardficate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor'Code, for the performance of the work,for which this permit is
issued.
I have and will maintain workers' compensstion'insurence, as required by Section 3700 of the Labor
Code, for the performance of the work,forrwhich this permit.is issued. My workers' compensation
insurance carrier and.policy number.are,
Carrier STATE FUND Policy tuber 1818777-2005
_ I certify that; in the performance of number/
rk for which this permit is issued, I shall not employ any
person in any manner so as to beco subject to the workers' compensation laws of California,
and agree that, If I should'become jeer to the workers' compensation provisions of Section
y 3700 of the Labor Code, II fo with comply with those provisions.
ll3te: U Applicants
WARNING: FAILURE TO SECURE WORKS 'COMPENSATION'COVERAGE'IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL P.ENALTIE§ AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (8100,000)• IN ADDITION TO THE COST OFCOMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706'OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this. application..
1. Each person upon whose behalf this application is made; each person at whose request and for
whose benefit'work'is performed under or pursuant to any permit issued as a result of this application;
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quints, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this•applicationbecomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
1 certify that I have read this: application and state that the above info rmatio s correct. I agree to comply'with all
city and ~ordinances and state laws.relating to bugs ing constructs , and hereby authorize' representatives
of this my to en or upon the above mentioned p for n purposes.
Date:. I '� Signature (Applicant or Agent)::
Application Number . . . . . 06-00000268
Permit . . WALL/FENCE .PERMIT
Additional desc . .
Permit Fee . . . . 54.00 Plan Check Fee 00
Issue Date Valuation . . . . 2500
Expiration Date . . 7'/17/0'6
Qty Unit Charge Per Extension
BASE FEE 45.00
1.00 9.0000 THOU BLDG 2,001-25,000 9.00
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Special Notes and Comments
100 L.F. 6' GARDEN WALL, CITY STANDARD.
Fee summary Charged.
Permit Fee Total 54.00
Plan Check Total .00
Grand total 54.00
LMiL. c1 1
Paid_ Credited Due
.00 .00 54.00
.00 .00 .0.0
.00 .00 54.0.0