08-0336 (SPIN)-.—
P.O. BOX. 1504 TdY444"- VOICE (760) 777-70.12
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 2/22/08
Application Number: 08-00000336 Owner:
Property Address: 77186 CASA DEL SOL ANSCHEL HAROLD
APN: 773-360-005- - -
Application valuation: 100
Contractor: D p
Applicant: Architect or Engineer: HBA DEVELOPMENT
P.O., BOX 605
HERMOSA BEACH, CA 90215.1 FEB 2 2 2008
(310)318-1580
Lic. No.:. 654540
. 'Ty
OF 11_Aq gU1NTq
FINANCE DEPT;
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm Linder penalty of perjury that I am licensed under provi ions of Chapter 9 (commencing. with I hereby affirm under penalty of perjury one of•the following declarations:
Section 7000) of Division 3 of the Business and Professionals C , a� my License is in full force arid effect. _ I have and will. maintain a certificate of consent to self -insure for workers' compensation, as provided
License ass: n o.: 654540 for by Section 3700 of the.Labor Code, for the performance of the -work for which this permitis
issued.
ate -2 �Z -rector: ' have'and will. maintain workers' compensation insurance, as required by Section 3700 o£the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION
I hereby. affir under penalty of perjury that I am exempt from the Contractor's State License Lawfor the
followingreason(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,that he-or.sheisJicensed pursuant:to.the provisions of the- ,Contractor's State
License Law (Chapter 9 (commencing with.Section 70001 of Division of the Business and Professions'Code) or
that he or she is:exempt therefrom and the basis for the alleged exemption. AgyrViolation of Section 7031.5 by
any applicant for a permit subjects the applicant to acivil penalty of not more than five hundred dollars.(5500).:
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work; and
the strucbire'is.not intendedor offered'forsale (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 dhrough.his or her own employees; provided that the
improvements are not intended or offered.for sale. If, however, the building or improvement'is sold within
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.).
(_) 1,'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 improvesthereon, and who contracts for the;projects with a contractor(s) licensed
pursuant to the Contractors' State License Law:)..
II am exempt under Sec.. ;.B.&P.C. for this reason
Owner:
CONSTRUCTION LENDING AGENCY'
I hereby affirm under penalty of perjury thatthereisa construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097,,Civ.'C-.).
Lenders Name:
Lender's Address:
r
LQPERMIT
insurance carrier and policy number are:
Carrier EXEMPT Policy Number EXEMPT
I
certify hat'
in the.performenedof the work for _ c y this.pi rmit,is'is_sue all note ploy.eny
person in any manner so as to become subj to to workers' cent nsat♦ n.laws alifornia;
rid agree that, if I should.becomesubjec o workers' comp sat r(provisio f Section
700 oft bon e, I shell forthvi' mply with those ons.
ate:q:l
pplicant:
WARNURETO SECURE WORKERS' COMPENSATION:COVERAGE IS UNLAWFUL, AND SHALL
SUBJEPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100A00). IN ADDITION TO THE COST OF COMPENSATION, 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 restrictionsset forth on.this..application.
1. Each person upon whose behalf this application is made, each person at whose, request and for
whose benefitwork is performed under, or pursuant to any permit issued asa result of this application;
the owner, and the applicant, each agrees to, and shall.clefend, indemnify and hold harmless the City
of La Quints, its officers, agentsand employees forsany,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 -application becomes null and Void if work is not commenced
within 186 days from date of issuance of such permit, or cessation of work for 180 days will le
permit -to cancellation.
1 certify that I have read this application and state that the above'information is corre ree to co ly wit
city an umordinances.and state laws relating to building construction, and h- - authorize rep sent
oft ' unty olnter upon above-mentioned prope y for inspection pur
Data. Ty nature (Applicant or Agen -
W _ .
Application Number . . . . 08-0.0000336
Permit . .
. SPECIAL INSPECTION
Additional desc .
.
Permit Fee . . .
. 100.00
Plan Check
Fee..
.00
Issue Date . .
.
Valuation
. . .
. 100
Expiration Date
8/20/08
Qty Unit Charge Per
Extension
BASE FEE
100.00
Special Notes and
Comments
SPECIAL INSPECTION
BEFORE FINALLING
SFD.NO INSPECTIONS
ON PERMIT # 04-6143
SINCE 12/20,[06
Fee summary
Charged Paid
Credited
Due
----- ------ ----
Per -`mit Fee Total-
--------------------
100.00
----------
.00
-------
.00
-
100.00
Plan Check Total
..00
.00
.00
.00
Grand Total
100.00
.00
.00
10.0.00
LQPERMIT