05-3000 (BLCK)a
}
P.O. BOX 1504'.:,
.78-495 CALLE TAMPICO -
LA QUINTA,-CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT `
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BUILDING PERMIT
Application Number: X05=00003000
:Property Address: 81875 VIDA BELLA DR `
APN: 764-010-011-24 -30092
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAI
Application valuation: 2275
Applicant
-
Architect or
VOICE. (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) .777-7153
Owner: I -
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
Date: 7/19/05
• LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION -
I hereby. affirm under penalty of perjury that I am licensed under provisions of Chapter 9.(commencing with
I hereby affirm under penalty of perjury one of the following declarations: a
Section 7000) of Division of the 8usines gd'Professionals Code, my Licensejs in full force and effect. . —�
_ I have and will maintain -a certificate of consent to self -insure for workers'. compensation, as provided
License Class: 'cert
- for by Section 3700 of the Labor Code, for the performance of the work for which this permit is -
o/�,
issued.
° Date: / I1 5 Contractor: •
_ 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
OWNER -BUILDER DECLARATION
insurance -carrier and policy number are: I
hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier B Policy Number - - - - - - - - - - - = - - - "
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any ,
construct, alter, improve, demolish; or repair any structure, prior to its issuance, also requires the applicant for the
- person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should b TI.:Object to vorkers' compensation provisions of. Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions. Code) or -
3709 gf the Labor C ; I shall fo pl with those provisions.
- that he or she is exempt therefrom and. the basis for the alleged exemption. Any -violation of Section 7031.5 by
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4
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date: Applicant: -
(_) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SE RE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
`
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS (5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN.
- - improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. .
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.). •l_
• ' APPLICANT ACKNOWLEDGEMENT
(_ 1 1,as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.,
IMPORTANT Application is hereby made to the Director'of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
• property whobuilds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
- - - pursuant to the Contractors' State License Law.). _
whose benefit work is performed under or pursuant to any permit issued as a result of -this application,
I_) I am exempt under Sec. , B.&P.C. for this reason -
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
• _ -
of La Quints, its officers, agents and employees for any act or omission related to the work being
"
performed under or following issuance of this permit.
. Date_: Owner.
• 2. Any permit issued as a result of this application becomes null and void if work isnot commenced L
within 180 daysfrom date of issuance of such permit, or cessation of work for 180 days will subject -
CONSTRUCTION LENDING AGENCY
permit to cancellation.
" I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I,have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ: C.). - - -
city'and county ordinances and state laws relating to buildin nsts"8otion, and her erize-representatives
-
Lender's Name:
of this court to enter the above-mentioned pr, specti uses.
_
• _ - 'Y .
Date: /�-0 ignature (Applicant or Agent)
.-
Lender's Address:-
'
LQPERMIT
" Application.Number_ 05-000030.00
"
Permit . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . 54.00
Plan Check
Fee
.00
Issue Date
Valuation
2275
Expiration Date 1/15/06
Qty Unit Charge Per
Extension
r BASE. FEE
45.00
.1.00 9.0000 THOU BLDG 2,001-25,000
9.00•
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Special Notes and Comments
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---------------
91 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
LQPERAIIT - -
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