05-3578 (BLCK)4.14 VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/11/05
Owner:
K: HOVNANIAN FORECAST HOMES
SE
4240 E.' JURUPA'ST: STE. 402
Lf11a .R CHINO, CA 91710
U SEP 21 2005 U
Contractor:
nee CITY OFLAQUINTA K. HOVNANIAN FORECAST. HOMES
FINANCE DEPT. • WCC: ZURICH INS
WC: WC343666302 10/31/05
CSLB: 700788 .10/31/05
LICENSED CONTRACTOR'S DECLARATION
WORK ER'S'COMPENSATION DECLARATION .
I hereby affirm under penalty ofperjurythat I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations: -
P.O. BOX 1504
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
78-495 CALLE TAMPICO -
LA QUINTA, CALIFORNIA 92253 r
Application Number:
05-00.003.578`
Property Address:
81952 VIDA BELLA DR
APN:.
764-010-011-31' -30092 -
Application description:.
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
2125
Applicant:
Architect or Er
4.14 VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/11/05
Owner:
K: HOVNANIAN FORECAST HOMES
SE
4240 E.' JURUPA'ST: STE. 402
Lf11a .R CHINO, CA 91710
U SEP 21 2005 U
Contractor:
nee CITY OFLAQUINTA K. HOVNANIAN FORECAST. HOMES
FINANCE DEPT. • WCC: ZURICH INS
WC: WC343666302 10/31/05
CSLB: 700788 .10/31/05
LICENSED CONTRACTOR'S DECLARATION
WORK ER'S'COMPENSATION DECLARATION .
I hereby affirm under penalty ofperjurythat I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations: -
Section 7000) of Division'3 of the.Business.and Prof ' nals Code, a License is in Viand effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: Lic
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
�/
issued.
✓ Date! 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 -B ILDER 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, priorto 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
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
and agree that, if I should be subje a workers' compensation provisions of Section
/ e Labor C shall fo ith ly with those provisio
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
13700 e
! �/ ~
any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars 155001.:
.
Date: Applican
(_) I, 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 SECURE 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 ($100,000). 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.).
- APPLICANT.ACKNOWLEDGEMENT
(_ 1 I, 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. ._
propertyw6o builds 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 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 Quinta, 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 is not commenced
•
within 180 days from 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 Imply witl
work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances'and state laws relating to building construction, and h�ereb � a repre Ives
of thi ounty to enter upon the above-mentioned f pection o5�s.
Lender's Name:
/property
,�/
_�/
Date: i nature (Applicant or A nt): '
9e
Lender's Address:
LQPERMTT
i Application Number . . . . . 05700003578
Permit' WALL/FENCE
PERMIT
Additional desc .
Permit Fee 54.00
Plan Check_ Fee
.00
Issue Date...
Valuation
2125
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
85 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