05-3589 (BLCK)57885 Arpeggio Drive
70
t
O. BOX 1504 -- IE- - --
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
:i
05-00003589
5 -7885 -ARPEGGIO DR
764-010-011-58 -30092
WALL/FENCE
LOW DENSITY RESIDENTIAL
8775
Architect or
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (co with
Section 7000) of Division 3 of the Busines r .e essionals Code my Licen 'stfifull force and effect.
Licen Cla,/j:
ate: ^ Contractr:
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, 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 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 a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_ 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 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 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 improves thereon, and who contracts for the projects with a contractors) 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 hereby affirm 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/11/05
Owner:
K. HOVNANIAN FORECAST HOMES
4240 E. JURUPA ST. STE. 402
CHINO, CA 91710
Contractor:
K. HOVNANIAN FORECAST HOMES
WCC: ZURICH INS
WC: WC343666302 10/31/05
CSLB: 700788 10/31/05
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
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' compensation insurance, 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:
Carrier B Policy Number - - - - - - - - - - - - - - -
I certify that, in the performance of the -work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' com a6wrlawsyof California,
and agree that, -if I should bec subj F ovmons.
'
ns,
provisions of Section
3700 the Labor Cod all for
at.'T _r0Applicat:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
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 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 Quinta, 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 application becomes 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.
I certify that I have read this application and state that the above inf ation is correct. I agree to comp) with all
city and countyyordinances and state laws relating to buildin struction, and here au rize r entatives
of this cou y to enter on the above-mentioned pr gfi ori ection
Date: ature (Applicant or Agent)::
,4
LQPERMU
Application.Number
Permit . . .
Additional desc . ..
Permit Fee . . . .
Issue Date
Expiration Date .
. . . . 05-00003589
WALL/FENCE PERMIT
108.00
2/07/06
Plan Check Fee 00
Valuation . . . . 8775
Qty Unit Charge Per Extension
BASE FEE 45.00
7.00 9.0000 THOU BLDG 2,001-25,000 63.00
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Special Notes and Comments
351 L.F. 6' PROPERTY LINE WALLS, PROTO
STANDARD.
Fee summary Charged Paid Credited- Due
---------------------------------------------------------
Permit Fee Total 108'.00 .00 .00 108.00
Plan Check Total .00 .00 .00 .00
Grand Total 108.00 .00 .00 108.00