07-0191 (BLCK)cal
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
�"' 0-7=0_0_0_0'0_r91
Property Address:
`-43100-PALM-ROYALE DR
APN:
609-051-010- - -
Application description:
WALL/FENCE
Property Zoning: .
HIGH DENSITY RESIDENTIAL
Application valuation:
.624
4
ily�l � �Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
WRM LA QUINTA
1000' E'80TH PLACE STE 700 N
MERRILLVILLE, IN 46410
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/18/07
Contractor. /A\
Applicant: Architect or Engineer. WPM CONSTRUCTION -CA LP (�
D
1000 EAST 80TH PLACE, ##-• N. j
MERRILLVILLE, IN 46410 JAN 9 8 2007 i
(219)680-5000 ftl 1
Lic. No.: 825987
CITY OF LA QUINTA
FINANCE DEPT.
' 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:
Section 7000) of Division 3 of the Busin anJProf 'ovals Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
e ass: B License No.: 825987 _
for b Section 3700 of the Labor Code, for the performance of the work for which this permit is .
Y
(
LDate:,
issued.
I have and will maintain workers' compensation insurance, as requiredby 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:
hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier ZURICH •AMERICAN - 'Policy Number WC930464404 -
-. following reason (Sec. 70:11.5, 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 s 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 sho ecome su ' to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Co , I shall fort) it comply with those provisions. '
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).:.
'Date: I It) 0 ,._ Applicant:
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
plicantt:
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 '
(_) 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, usiness and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a -contractors) 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,
1 _ 1 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
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
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 isnot 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 bove information is correct. I agree to comply with all.
city -and county ordinances and state laws relating to buil i g constr i and hereby authorize representatives
of this county to enter upon the above-mentioned prope y or insp on urposes. -
f $ � Signature r_Agentl:
Application Number 07-00000191
`
Permit `. WALL/FENCE PERMIT
Additional desc .:
Permit Fee 19.00 Plan Check
Fee
.00
_ Issue -Date . . Valuation
". 624
Expiration Date 7/17/07,
Qty Unit Charge Per
Extension .
" BASE FEE
15.00
2.00 2.0000 HND BLDG,501-2,000
.4.00.
special 1VOL25 Ahd (omrrients-----
..7----------
; ----
14 LF MONUMENT SIGN NE CORNER OF.
WASHINGTON/PALM ROYALE. 16 LF MONUMENT'
-
SIGN NEAST.CORNER OF ENTRANCE OFF PALM
}.
ROYAL..ORCO STANDARD•& PER APPROVED -
. PRECISE/LANDSCAPE PLANS.
Fee summary Charged .Paid Credited
Due
-- - - - -- - ------ - - -
Permit •Fee ''Total 19.00" •.00
- - -
.00
----------
19.00
Plan Check Total .00 .00
.00
.00
'Grand Total 19.00 .00-
.00
19.00
LQPERMIT .,. .. -
,•
Bin #
City of La Quinta
Building a Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
07, M
Project Address: +3 -l0'D PA --al rzp.r�,E
Owner's Name: (,t) 2M 4A--aL)1Xp
A. P. Number:
Address: ( ooa r_ �f H �S,7r TESD
Legal Description:
City, ST, Zip:n4 u, I Uc—
Contractor: tiiif PNl GDM eTF-(�P 11 G,4 . `, j?
Telephone: 17,1 1) - (P,150 - 500 o
Address: 4'7 - l e -o PA4 fA
Project Description:
�i pA-�t�N�c�rrS
City, ST, Zip: I -A - Q U t �F A a,a 9 22
Telephone: ?(ou-'1�t4'-524 I
(,F �fZ N -bill/ IuLC G�IGI� 5
State Lic. # :
City Lic. #:
Arch., Engr., Designer: J,014 -►,J Vot: L g /ori b�
t -F FOP— &10 AJ V kt Gf,,r 4A 46 9)
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
P cY:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Chect Balance
Energy Cates.
Plans picked up
Constructi 3n
Flood plain plan
Plans resubmitted
Mechanical
Grading, plin
2°' Review, ready for correctionsrssue
Electrical
Subcoutactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''' Review, ready for. corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees