08-0337 (SPIN)4 -
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
08-00000337
Property Address:
77154 CASA DEL SOL
APN:
773-360-007- -
Application description:
SPECIAL INSPECTION
Property Zoning:
MEDIUM DENSITY RES
Application valuation:
0
Applicant: Architect or Engineer:
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LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penally of perjury that I 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 fulCforce and effect.
License Class: License.No.:
Date: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
followingreason (Sec. 7031.5, Business and Professions Code: Any city or county thati requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also:requires the applicant for the
permit to filea,signed statement that he 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 Business and Professions Code) or
that he or she is -exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for permit subjects the applicant to_a civil penatty`of not more than fivehundred dollars ($500).:.
(_ 1 1, as owner of -the property, or my employees with wages..astheir sole compensation, will do the work, and
the structure is not intended.oroffered'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 through his or her own employees, provided thaf,the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
oneryearof completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose ofsale.).
1 _ 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 Lawdoes not applytoian owner of
property -who builds or improvesthereon, and who contra ((( the proje t ith a contr? Loris) licensed
pursuant to the Contractors' State License Law.). � ��
(_) I'am eximpt tinder Sec. B :&P.C: for this r on
1 A
Dater
Owner•.
CONSTRUCTION LENDING AGENCY.
I herebyaffirm under penalty of perjury that there We construction lending agency for thetperformancwof the
work for which this permit is issued (Sec. 3097, Civ. CJ.
Lender's Name:
Lender's Address:
LQiPERMIT
Owner:
ANSCHEL HAROLD
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/22/08
4FEB 22 2006
'�OFLAou.r�_ I
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WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a'certificate of consent to:self-insure for workers' compensation, as provided
forby Section 3700 of the Labor Code, for the performance of'the work for which this permit is
issued.
I have and will maintain workers'.compensation insurance, as required by Section 3700 of thaLabor
Code, for the performance of telwork for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier =--- .-_-----Policy Nu ber
I certify that, in the performance of the - r which this, per .iss d, I shall not employ any
person in manner so,as to bac ens leIthe,worke
the n s' comp Serio. laws of Calif
or ' ,
and agree4hat; 'rf I should Deco- subj to comps ation visions of n3700 of the Labor , I Sha o- ith cowi those - visio
Date: 2 Applicant:
WARNING FAILURE TO SECURE WORKERS' COMPENSATIO COVERAGE IS UNLAWFUL,'AND ALL
SUBJECT kN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UPTO ONE HUNDRED THO SAND
DOLLARS ($100,000). 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 restrictions set forth on,this application.
'1: Each personluponwhose 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 Quinta, its officers, agents and employees for any act or omission related to the work being
performedunder or following issuance.of this permit..
2. Any permit issued as,a result of this application becomes null and'voidif work is not: commenced
within 180 days from date of issuance of such permit, or cess ' n of workfor 180 da •will subject
permit to cancellation..
I certify that I have read this application and state.that the above infor atio scorrect,. I a to c_ pl i all
city and county ordinances and state laws relating to bui ing const ctio and hereby au oriie r tali s
of this co my t enter upon the above-mentioned pr for in t purposes.
Date: � Signature jApplicant,or Agent .
Application. Number . . . . . 08-00000337
Permit . .
. SPECIAL INSPECTION
Additional desc .
Permit Fee . .
100.00
Plan Check
Fee
.00
Issue Date -.
Valuation
. . .
. 0
Expiration Date
8/20/08
Qty 'Unit Charge. Per
Extension
BASE FEE
100.00
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Special
Special Notes and Comments
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-
SPECIAL INSPECTION
TO FINAL HOUSE.
PERMIT #04-6144
Fee summary
Charged Paid'
Credited
Due
Permit Fee Total
100.00
.00
.00
100.00
Plan Check Total
.00
.00
.0,0
.00
Grand Total .
100.00
.00
.00
100.00
LQPERMFr