05-3591 (BLCK)P.O. BOX 1504
78495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 'W0.5,j,Q_0 0 5.91
Property Address: 57895 PASATIEMPO CT
APN: 764-010-011-90 -30092
Application description: WALL/FENCE
Property, Zoning: LOW DENSITY RESIDENTIAL
-App lication.valuation: 2125
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:' U SE 212005
?005:
l clrr�A-
/
Ff�
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensad'under provision of Chapter
Section 7000) of Division 3 of the Businessand 'Pr ionals C y;License i< -
License Class:' ice'a
•Contractor
OWNER- UILDER DECLARATION
and effect.
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-,, 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 _ 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
infendedor 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 himselYor 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,purposeof sale.). -
(_) I, as�owner of the property, am exclusively contracting with licensedcontractors 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 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:
LQPERMFr
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
ntrdctur:
HOVNANIAN.FORECAST HOMES
CC: ZURICH INS
C: WC343.666302 10/31/05
SLB: 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 maintainworkers'. compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for whichthis 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 toybecome ubject to the workers' compensation laws of California,
and agree that, if I should bec sect to the wo rs' compensation provisions of Section
3370y0�e Labon/Cad all forthwith comp) tho
Date: I ""'ApplicantY•
WARNING: FAILURE TO SECU WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TOCRIMINAL 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 Ouinta, 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 information is correct. I awe -to comp!�-.
city and county ordinances and state laws relating to building conation, -and authorize sentatives
of this co ty.�••��[oo/f mer -the above-mentioned-propert ` nr> specti pos
gi
Dat`�� lure (Applicant or Agent
Application Number . . . . . 05-00003591
Permit WALL/FENCE
PERMIT
Additional desc .
Permit .Fee . . . . 54.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 2125
Expiration Date 2/07/06
Qty Unit Charge Per
Extension
BASE
FEE
45.00
1:00 9.0000 THOU BLDG
2,001-25,000
9.00
- -------------------,-,--------------
Special. Notes and Comments
------------------
------
---------------
s• 85 L.F. 6" PROPERTY LINE WALLS,
PROTO
STANDARD.
Fee -summary Charged
Paid Credited
Due
.,------------------
Permit Fee Total 54.00
----------
.0.0.
----------
.00.
54.00
Plan Check.Total 00
60
.00
:00
Grand -..Total 54.00
00
.00
54.00
LQYERMIT _