05-3002 (BLCK)i 'P.O. BOX 1504
is 78-495 CALLE TAMPICO
s LA QUINTA; CALIFORNIA 92253'..
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date
Application Number:
05=00003-002
Owner:
Property Address:
81844 VIDA•-BELLA DR
K. HOVNANIAN FORECAST
HOMES
APN:
764-010-011-37 -30092 -
_
®
4240 E. JURUPA.ST. STE.
402
Application description:
WALL/FENCE
D
CHINO, CA 91710
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
2175
SEP 212005
Contractor:
Applicant:
Architect orEngj
eer: CITY-OFLAQUINTA
K. HOVNANIAN FORECAST
HOMES
I=INANCEDEP4:
WCC: ZURICH INS
WC: WC343666302
10/31/05
CSLB: 700788
10/31/05
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter mmencing with
Section 7000) of Division 3 of the Business rofessionals Code, and my se is in full force and effect.
License Class:is n e No.:
Date—'^ Contractor:
OWN -BUILDER DECLARATION
hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
followingreason(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 file a signed statement that he or she is licensed pursuant to 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. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to acivil penalty of not more than five hundred dollars ($500).:
(_) 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
Contractors' State License Law does not apply to an owner of property who builds or improves 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.).
(_) 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 to an owner of
property who builds or improves thereon, and who contracts for the projects witha contractor(s) licensed
pursuant to the Contractors' State License Law.).
I—) I am exempt under Sec. , B.&P.C. for this reason
Date: Owner: r
' 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:
LQPERMIT
WORKER'S COMPENSATION DECLARATION
7/19/05
I hereby affirm under penalty of perjury one of the following declarations:
1 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.
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 Policy Number - - - - - - - - - - - - - - -
I certify that, in the performance of the work for which this permit is issued, 1 shall not employ any
person in any manner so as to become subject to the rs'-Eompensation laws of California,
and agree that, if I should a subiect to -Workers' compensatio ions of Section
3798•'6f the labor e, I sh forth comp ith those ions. --
Date )/' 3 Applicant: '
WARNING:, FAILURE TO SECURE WORKERS' COMP SATION 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.
1
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 followingissuance 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 i rmation is correct. I agree to comp) l'_
city and county ordinances and state laws relating to buil nstruction�end her y authorize entatives
of this o/u�n/ty to entepon the above-mentioned pr rty for ins -
Date: oz )��nature (Applicant or Agentl:
Application Number .05-00003002
•Permit WALL/FENCE PERMIT
Additional desc .'.
- Permit Fee 54.00
Plan Check
Fee"._
.00
:-: Issue Date
Valuation
. . .
. 2175
Expiration Date.. 1/15/06
Qty Unit Charge .Per,.
Extension
BASE FEE
45.0.0
1.00 9.0.000 THOU BLDG 2,001-25,000
9.00
------------
Special.Notes and Comments-
omments _87
------------
------
---------------
87L'. 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
LQPERNIIT _ - -