06-3072 (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:
-._ l . .
06-00003072_'
43100 PALM ROYALE DR
609-051-010- - -
WALL/FENCE
HIGH DENSITY RESIDENTIAL
41375
Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
yJ•.IeA &A (�IUrNT{l/1�ed,7nw /}fI1JDate: 11/05/06
Owner: _ _
I JOA
Nle B -740AI
' sN yf� tisvv
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 Bu ' ss and rofessionals Code, and my License is in full force and effect.
License C as B License No.: 825987
Date: p aI Contractor. "#A QQn'T• ��
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 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 a civil penalty of not more than five hundred dollars ($500).:
(_) I, as owner of the property,. or my employees with wages as their sole compensation; will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with contractor(s) licensed
.pursuant to the Contractors' State License Law.). .
(_) I am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the, performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Contractor: i
WPM CONSTRUCTION -CA LP NOV � � 2006 �I$
1000 EAST BOTH PLACE, #555 N. i
MERRILLVILLE, IN 46410
(219)680-50.00 CITY OE LAQUINTA
Lic. No.: 825987 FINANCE DEPT_
------------------
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.
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 ZURICH AMERICAN Policy Number WC930464404
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as.to become subject to the workers' compensation laws of California,
and agree that, if I sh e d become bject to the workers' compensation.provisions of Section
3700 of the Labor C de I shall for ith comply with those provisions.
'Date: L _Applicant: - Empm toOtArl e.4
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 (5100,000). 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 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 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 1$0 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 ve informati is correct. I agree to comply with all
city and county ordinances and state laws relating to build' g onstructi hereby authorize representatives
of this count to enter upon the above-mentioned propert for ns�cti p r es.
Date: N Signature (Applicant or Agent):
Application Number 06-00003072
Permit WALL/FENCE PERMIT
Additional desc RETAINING / SCREEN'WALLS
Permit Fee . . 362.50 Plan Check
Fee .,
.00
Issue Date Valuation,
41275
Expiration Date 5/04/07
Qty Unit Charge Per,
Extension
BASE FEE
252.00
17.00. 6.5000 THOU BLDG 25,001-50,.000
110.50
Special Notes and Comments
1651 LIN. FEET COMBINATION SCREEN &
RETAINING WALLS.2001 CBC:.
8FT MAX SCREEN W/ 6FT MAX RET= 1000
LF -NORTH PL, 331 LF -EAST PL, 144
�" LF -WEST PL.
6'-8" SCREEN WALL= 101'LF-EAST PL, 45
LF-NORTH.PL.'
10'-6" TO 11'-4" SCREEN WALL= 30
LF -WEST PL. **PERMIT DOES NOT INCLUDE
WROUGHT IRON FENCING.
Other Fees HOURLY PLAN CHECK
210.00
STRONG MOTION (SMI)
- COM
8.66
Fee summary Charged • Paid Credited
-----------------------------------------------
-
----------
Due
=- Permit Fee Total 362.50 .00 -
.00_ -
362.50
Plan Check Total .00 .00
.00.
.00
Other Fee Total 218.66 .00
.00
218.66
Grand Total 581.16 .00
.00
581.16
• LQPERn1IT -
-