07-1095 (BLCK)t
P.O. BOX 1504 r
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT -
Application Nuhibe,:
-
07'-00001095
ROYALE
Property Address:
—43100 -PALM DR
APN:
609-051-010- - -
Application description:
-WALL/FENCE
Property Zoning:
HIGH DENSITY RESIDENTIAL
Application' valuation:
1082 5.
Applicant:
Architect or Engineer: ••
' LICEN D CONTRACTOR'S DECLARATION
- - _ - - -- - I hereby affirm under penalty of perjury that I a censed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business a ofessionals Code, and my License is in full force and effect. -
license CIa s:' B i s No.: 825987
Date: Contractor: ,
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 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.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
-rnnn, c Cin„C.,::,nn profoctient, r„f,: Tp,; (; gntrgntq•p' s;gtn i i9n!1 e i ck�., ;t,;69 ,,,;t npf'!Y to en o nor of
'property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Cont rectors' State License Law.). -
1 ) 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:
f
LQPERMIT - -
Owner: rJ
WRM LA QUINTA
1000 E. BOTH PL, SUITE,70
MERRILLVILLE, IN 46410
w ('219)"736-2418
Contractor:
WPM CONSTRUCTION -CA LP
1000 EAST 80TH PLACE,
MERRILLVILLE, IN 46410
(219)680-5000
Lic. No.: 825987
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/19/07
v
SPR 2 12007
CF �� L'4 QIIBg(TI5
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#555 N
WORKER'S COMPENSATION DECLARATION -
I hereby affirm under penalty of perjury one of the fallowing declarations: _ - -- - - - - - r• - - • -
_ 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 t ecome sAcly
workers' compensation laws of California„
and agree that, if I should b o e subjeers' compensation provisions of Section
3 �f10 of the Labor Code, I he forthwitthose provisions.
Date: ' Z� ul Applicant:
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 ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LIBOR CODE, INTEREST, AND ATTORNEY'S FEES. .
APPLICANT ACKNOWLEDGEMENT -
IMPORTANT Application is hereby made to the Director of Building and,Safety for apermit subject to the _
adnditiono and rowiotiono got forth on thio 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 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 aboinformation i rrect. I agree to comply with all
city and county ordinances and state laws relating to building o struction, ano Pereby authorize representatives
of this cou y to nter upon the above-mentioned propert f r i c on pu S.
Date: 7-'5 Signature (Applicant or Agent): ,.
t
Application Number. . . . . 07=00001095
Permit . . . . . . WALL/FENCE PERMIT
.
Additional desc .
Permit Fee . . . 126.'00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 10825
Expiration Date 10/16/07
Qty Unit Charge Per.
Extension`.
• BASE FEE
45.00
9.00 9.0000 THOU BLDG 2,001-25,000
81.00
Special Notes and Comments
500 L.F. ALLAN BLOCK LANDSCAPE WALLS
FROM GROUND LEVEL TO MAX. 41-611, PER
APPROVED PLANS:2001 CBC.-
Other Fees . . .. STRONG
MOTION (SMI)
- RES
1.08
Fee summary Charged Paid
Credited
Due
Permit Fee Total 126.00-
.00
.00
126.00
Plan Check Total .00
.00 ..00
.00
Other Fee Total 1.08
.00
.00
1.08
Grand Total 127.08
.00
.00
127.08
"
r
LQPER\11T