05-3582 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA 'QUINTA, CALIFORNIA 92253
Application Number: c0.5�000035821--p
Property Address: 57815 PASATIEMPO CT
APN: 764-010-011-92 -30092 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 2125'
Applicant: Architect or Engineer:
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LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I am licensed under_ provisions of Chapter 9 (commencing with.
Section 7000) of. Division 3 of the Business. nd Professionals Code, and my License isJn full force and effect.
License Class: ` ` r v, icense No::. _.
--'D'ate V ,' Contract' {
l ,
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt frointhe 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
c0nstruct,.alter,'improve demolisfi,.or repair. any structure; prior to, its issuance, also;requires the applicantfor the
,permit to,file.a signed statement that he'or'she is licensed pursuant;to the provisions of the Contractor'sState
License Law (Chapter -9 (commencing;with-.Sec-tion 7000) 6f,, -Division 3 of the Business and Professions Code) or
that he or som
he is exempt therefr•and�the basis for the allegd exemption Any violation of Section 7031.5 by .
any applicant for a permit subjects the m
applicant to a civil penalty of not ore tfibn f ve hundred dollars IS5001::
1 1 .I, as owner of the property, or my employees witfi'wages as their sale compensation,, will do the work, and
'the structure is not intended or offered forsale'ISec. 7044 Business and Professions_Code: The .e
Contractors'. State license Law does not apply to. an owner 0f:property whobuilds. or improves thereon,
and vAo does the.work himself or.heiselfthrough'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 owper 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 orimproves thereon, and who contracts for the projects with a contractor(s)� licensed
pursuant to the Contractors' State License Law.).
( 1 I am exempt under Seca , B.&P.C. for this reason '
P
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:
LQPERNUT
VOICE (760) 777-'1012
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 917.10
• ractor:
HOVNANIAN.-FORECAST HOMES
" C: ZURICH 'TNS y
C: WC343,666302 10/31'/.05
-SLB: 700.788 10/31/05 -
WORKER'S.COMPENSATION'DECLARATION '
Lhereby affirm under penalty;of perjury one.of the following declarations: -
I have and will maintain a. certificate of consentto,self-insure for workers' compensation, as provided
'.for 3
by Section 700 of the Labor -Code; for the performance of the work for which this permit is
Xissued. ' .� '.•�, _
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 policy number are:.,
Carrier B + ZPolicy'Number - - - -- - - - - --
I certify that; in the performance:of'the work for which this permit is issued;.I shall not employ any - v
. person in-iny manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject tojhe'workers compensation -provisions of Section
3700 of -the Labor Code 1 01 orthwith,co ply wfth'those provisions.
,}
ate' plican�
WARNING: FAILURE -TO SECURE WORK ERS'.COMPENSATION- COVERAGE .,IS',UNLAWFUL, AND SHALL ...
SUBJECT AN EMPLOYER - To CRIMINAL PENALTIES AND CIVILfINES UP TO:ONEHUNDRED THOUSAND '
DOLLARS Q00,000),*IN ADDITION To THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR,IN
'SECTION 3706:OFTHE 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 Quintajts officers, agents and employees for any act or omission related to the work being
performed under"or ,followingissuance -of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180days 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 agree to comply with all
city and county ordinances and state laws relating to building G nstr�rction, and 1�7er by authorize representatives .
of thissccounntyt000 enntterroPon the above-mentioned property for/ns recti of-Lrp s
Daftmature (Applicant or Agent). .
Application Number . . . . . 05-00003582
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,,0.01-25, 000
9.0`0"
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Special
Special Notes. and Comments
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85 L.F. 6' PROPERTY LINE WALLS, PROTO
STANDARD.
Fee summary Charged Paid Credited'
Due
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Permit Fee Total 54.00. .00
.00
54 -.OD
•Plan• Check Total :0.0 .' .00
.00
.00
.Grand Total 54'.00. .00
.b0
54.00
i
-
LQPERMIT _" r