05-3586 (BLCK)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 X0_0 Off -T-58-6—
5777.0 PASATIEMPO CT
764-010-011-96 -30092
WALL/FENCE
LOW DENSITY RESIDENTI
-.:2225 :.
Architect or
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
AI; " -
D
Eng a SEP_2, 1 2005'
z
CITY j0FLA QUIPITA
FINANCE-DIEPT.
LICENSED,CONTRACTOR'S DECLARATION
herebyaffirm under penalty of perjury thatA,am licensed under provisions of Chapter1 (commencing with.'
Section -7000) of Division 3 of.th* '13' nes: nd Piofessio Is Code, and my License is in full force and effect:., `
License Class 'T' _ 4 , .:1,. Licens6,N0 . -:5• _ T'•
r
D te�._�.2l1!25C' ontractor�-
NEI
R-BUILDER DECLARATION.
I hereby affirWunder penalty m of'perjury that I aexempt from the contractor's State License Law for the
ow .
folling ieason.ISec. 7031 .5;;Business�and Professions Code: Any city-or'county'that requires apermit to
construct, alter, -improver -demolish; or repair any structure; prior to.its issuance;,also requires ethe applicant for the
,y permitto file a'Signed'statement that h_e orshe is licensed pursuant to the provisions of the Contractor'sState,
License Law (Chapter 9 (commencing with. Section 7000), of;Diyision 3 of the Business and Professions.Code) or
•:'that he or she is.ezempt therefrom and the:basis for the alleged exemption. Any vtolation,of Section •7031 5 by
t a
any applicant for a perm itsubjects the applicant.to a civil,penalty:of not more *than five hundred. dollars (S500).:
I I, as owner of the property; or my:1 16 ees with wages; as their sole compensation will do the work, and
'- the s(ructure is not intended 'oroffered for sale.(Sec.7044, Business and�Professions Coder The
Contractors' State License Law does not apply to an owner of property who tiuilds or'improves thereon,
and,who�does-the work himselforherself 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 thepurpose'of sale.)
1 _ 1 I, as owner of the property; ani 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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_) 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:
LQPERNUT
VOICE (760) 777-7012
FAX (760)-777-7011
INSPECTIONS (760) 777-7153
Date:
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
10/3.1/05
8/11/05
WORKER'S COMPENSATION DECLARATION' ,
hereby affirm under penalty of perjury one of the following declarations:
('have and will maintain a certificate.of consent to self -insure for workers' compensation, as provided
bySection 3700 of the Labor Code, for:the performance of the work for whicfi:this permit is
,�/ issued: .. • . ' . ,,
I have and will maintain workers' compensation insurance, as required bySection 3700 of the Labor
Code, for the performance. of the woik4or which this permit is issued. My workers' compensation
insurance carrier a!"' policy number are: '
Carrier B "PolicyNumber ---- •--— - - - - -- �:-.-
I certifythat,: in the performanceof: the work for which this permit is issued; I shaltnot employ any
personin.any_manner s. ,,so as -to become subject to�the workers' compensation laws of_Califoinia,
and agree that, if, l should;be.com ,_subject.to'the workers' compensation, provisionof Section
3700'of the Laborsl .f
b de, orthwi `'comp p with: those provisions..'
'Date• -��-��j'Applicant:,
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
'OO.LLARS (5100,000). `IN ADDITION TO THE COSVOF 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 fora permit subject to the
conditions and restrictions set forth on this application.
1 . Each person upon whose behalfthisapplication is made, each person at whose request and for
whose benefit work is performed under or pursuant to'anypermit 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 is correct. I agree to comply with all
city and county ordinances and state laws relating to buildir) constryyction, andreby authorize representatives
of this county to enter upon the above-mentioned property f 'ns iRi urp 3es.
D Signature (Applicant or Agent): '
Application Number . . . . . 05-00003586
Permit . . . WALL/FENCE
PERMIT
Additional desc . .
Permit Fee . . . . 54.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 2225
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
89 L.F. 6' PROPERTY LINE WALLS,
PROTO
STANDARD.
Fee summary Charged
Paid
Credited
Due
--------------------------------------
Permit Fee Total 54.00
----------
.00
----------
.00
54.00
Plan Check Total .00
.00
.00
.00
Grand Total 54.00
.00
.00
54.00
LQPERMIT