05-3583 (BLCK)k
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
,0:5--0.0'0-0 3'S8 3
57775 PASATIEMPO CT
764-010-011793
WALL/FENCE
LOW-DENSITY RE
1800•
cu
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S'DECLARAT
I hereby affirm under penalty,of perjury that I am licensed und'er,provisions of`Cha�
Section 7000) of Division 3 of the Business and ssionals C and my Lice6
Licen Class - ,- iceNo
9 (commencing with..
Iind effect.
Contract&;,::1!3
.F OWNER-BUILDER.DECLARATION
.I hereby affirm under penalty of perjury that) am'exempt from the Contractor's State License Law for the,
following'reasonl(sec. 7031'.5, Business yand .Professions Code: Any city -or county that requires apermit 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 (commencing with Section 7000) of D"vjsion 3 ofLtfie'Business%nd 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 peimn.subjects the applicant to a civil penahy.o6iot more than five hundred dollars ($500).: "
(_ 1. 1, as owner -of .the proper{y,.or my employees,with.wages as their sole compensation will A6 the work, and
the structure isnot intended oroffered for.sale.(Sec. 7044,`Business and Professions Code' Tlie .
., Contractors' State License Law does not,apply,town owner of -property who buildsior improves thereon,
and!whodoes"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 yearof completion; the owner-builder'will have the burden of proving that he di -she did not build or
.improve for the purpose of sale.). -
(_ 1 I, asownei of the property, am.exclusively contracting with licensed contractors to construct the project (Sec.
7044aBusiness and Professions Code: The Contractors' State License Law does not apply to an owner of
propertywho builds�orimproves thereon, and who contracts for the projects with a contractor(s),Iicensed
pursuant to the Contractors' State License. Law.). -
(_ 1 I am exempt;underSec. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury thatthere 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) 777-701.1
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: 700'788 " 10/31/05
WORKEW&COMPENSATION DECLARATION'
I hereby affirm -under penalty of perjury one�of,the following;declarations: -
I'have and.'will maintain -a oeriificate of consent to self -insure for workers' compensation,Ias provided
:for by Section 3700.of the Labor Code; for. the performance of the. work for'which this permit is
issued. »:.. _ r
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 ' •.. PolicV,Number- ----- .--- - - - - --
_ I certify that, in the performance of the work for which this permit is issued, 'Ishall not employ any
person in any manner so as to become'subject to theyvorkers' compensation laws of California, `
and agree that, if I shouId be co subject to th ;_ ers' compensation provision f:Section
3700 o e LabojasC all orthwith pl th,those pr '
J/Cp
Date: / : _Applicant: r --
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($10 0000). IN,ADDITION;TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED,FOR IN
SECTION 3706 OF THE LABOR CODE, INFEREST('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 information incorrect. I agree to coin ly with all
city and county ordinances and state laws relating to building c atrtBtion, and hereby a sentatives
ofyhig' untt to enter the above-mentioned probe rinspection pu
Date: �`� ignature (Applicant or Agent): '
Application Number . . . . . 05-00003583
Permit . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . . .41.00
Plan Check
Fee
.00
Issue Date . . .
Valuation
. . .
. 1800
Expiration•Date 2/07/06
Qty Unit Charge Per
Extension
BASE
FEE
15:0_0--
5:00"-
13.00-
13.00 2,00,00 -HND BLDG
'501=2; 000
26..00
- --------
Special Notes and ,Comments
------------------
-------
--------------
72 L`...F. 6' PROPERTY LINE WALLS,
PROTO.
STANDARD.
Fee summary Charged
Paid Credited
Due
Permit Fee Total 41.00
00
00
41.00'
Plan Check Total 00
.00
.00
00
Grand_Total 41.00,
.00
.00
41.00
LQPERMTT
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REVISI❑NS BY
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POOL & SPA SPECS,
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pIMl? CCP 420
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CONTROLLER
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