05-3584 (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:
`5 0_0:0_0.3_- __W
57735 PASATIEMPO CT
764-010-011-94 -30092
WALL/FENCE
LOW DENSITY RESIDENTIAL
5500
c&'4vl 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
SEP 21 ?005
Architect or Engineer:
C17'V.._ -
LICENSED CONTRACTOR'S DECLARATION
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 Busineh and Professionals Code, and my License is in full forceandeffect.
License Class: _cense No.:
Ynlract10
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 filea signed statement that he or she is licensed pursuant oto 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. Anywolation of Section 7031.5; by
any applicant for a permit subjects the applicant to a-civit'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 isnot intended or offered for sale (Sec. 7044; Business and Professions Code: The
Contractors' State License Law does not apply town owner. of property who builds-orimproves-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 I, 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 town 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 ISec. 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.' r,
I have and will maintain workerscompensation 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, Ishall*not employ any
_
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that,.if Ishould�bec9�f�a subject the workers' compensation provisions of Section
3700 of. the Labor Code I "O.forthw' 'comply with those provisions.
0.
10ate: pp,
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-thii 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 l have read this application and state that the above information jg'correct. I agree to comply with all
city and county ordinances and state laws relating to but nstruction, fid hereby authorize representatives
of this county to enter
rrlr upon the.above-mentioned prope y fo i c on
rposes.
Date?L/ nature (Applicant or Agent):
Application Number . . . . . 05-00003584
Permit . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 81.00 Plan Check Fee .00
Issue Date . . . . Valuation . . 5500
Expiration Date 2/07/06
Qty Unit Charge Per Extension
BASE FEE 45.00
4.00 90000.THOU BLDG ,2,0.01-25,000 36:'00
--
_ _..
Special. Notes and Comments
LQPERMIT-