06-0267 (BLCK)41 P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
06-00000267
Property Address:
77154 CASA DEL SOL
APN:
773-36.0-007- -
Application description:
WALL/FENCE
Property Zoning:
MEDIUM DENSITY RES
Application valuation:
2500
Applicant: Architect or
T419� 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that l am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License Is in full, force and effect.
Licenser "a"B License -No:: 654540
J"-: t 0 06 Cont:
OWNER,BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License law for the
following, reason (Sec. 7031.5, Businass,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 orshe,is licensed pursuant to the provisions:ofthe Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of'DlAsiom3 of the Business:and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.6.by
any applicant for a permit subjects the applicant to a:civil penalty of not more.than five hundred dollars (8500).:
('_ 1 I, as owner of the:propertv, 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 amownerof property who builds or improves thereon,
and who does.the work himself.orherself through his or her own employees, provided that the
improvements are not intended or offered for sale.. If; however, the buifding.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.).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7644, 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 I am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I.herebyaffirm under penalty of perjury that there is 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:
LQFERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/18/06
Owner:
ANSCHEL HAROLD
722 11 TH STREET
HERMOSA BEACH CA
HERMONSA BEACH, CA 90254
Contractor'
HBA DEVELOPMENT
P.O. BOX 605
HERMOSA BEACH, CA 90251
(310)318-1580
Lic. No.: 654540
WORKER'S COMPENSATION DECLARATION
I herebyaffirm-underpenalty of perjury one of the following -declarations:
_ I have and Will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance ofahe work for which this permit is
,Kissued..
I have and will maintain workers' compensationinsurpricei as required by Section 3700 of the Labor
Code, for the,performance of the work for which this permit is issued. My workers' compensation.
insurance carrier and policy number are:
Cartier STATE FUND Policy Number 1818777-2005
_ 1 certify that; in the performance of the work forwhich this permit is issued, I shall not employ any
person in any manner so as to bsco subject to the workers' compensation laws of California,
and agree that, if I should become bject to the workers' compensation provisions of Section
3700 of the Labor Cod I shell hwith comply with those provisions.
l � �'rApOficanjX
WARNING: FAILURETO SECURE WORKERS' COMPENSATIONCOVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN. EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (4100,000). IN ADDITION TO`THE'COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THEIABOR 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
condlitionsand restrictions setforth on this application.
1. Each parson 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 Ouinte,.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 restkof this application becomes null and void if work is ;not commenced
within 180 days from date ofissuance of such permit, or cessation of work for 160 days will subject
permit to cancellation.
I certify that 1.have read thisapplication and state that the above infotion is correct. I agree to comply with all
city arid county ordinances and state laws relatingtobuildinffipecli�n
n, and hereby authorize representatives
of this c my o enter upon the above-mentioned property f purposes.
D : I 0 I)1i Signature (Applicant q/Agent):.
Application Number 06-00000267
Permit. . .
. WALL/FENCE PERMIT
Additional desa .
Permit Fee . . .
. 54._00
Plan Check
Fee
00
Issue Date . .
.
Valuation
. . .
. 2500
Expiration Date
7/17/06
Qty Unit Charge Per
Extension
BASE
FEE
45.00
1.00 9.0000 THOU BLDG
2,0D1-25;000
9.00
-----------------------------
Special Notes and
Comments
-----------------
----------------
100 L.F. 2' COMBO
& 6' RETAINING
WALL,
CITY STANDARD.
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
54.0.0
[.QPERWr