07-1096 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA.92253
Application Number: _ _ 07_-00001096 t
c&ht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Property Address:
43100 PALM ROYALE DR
APN:
609-051-010- - -
Application description:
STRUCTURES. OTHER THAN. BUILDINGS
Property Zoning:
HIGH DENSITY RESIDENTIAL
Application \aluation:
9000
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that a licen a der provisions of Chapter 9 (commencing with ..
Section 7000) of Division 3 of the Business n Profe al Code, and my License is in full force and effect.
License Cl s: B nse No.: 825987
a. �J �(�
Date: ✓ f7 l 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).:
(_ 1 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 t9 an QWner-Qf
V)upei Ly wuu uulws Or ImprOveS tn6feon, and who coniracis for the projects with a contractor(s) licensed
pursuant to the Contractors' 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:
LQPER IIT
Owner:
DUTCH PARENT NV
38 NEWBURY ST
BOSTON, MA 2116
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Contractor: APR
� 2007 F
WPM CONSTRUCTION- LP CITYf
11 -.:_.._., ,
1000 EAST BOTH PLA #`��®l:aPviF/ti
MERRILLVILLE, IN 46410 V'®
EPT
(219)680-5000
Lic. No.: 825987
6TH
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/19/07
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 soast becom subject to the workers' compensation laws. of California,
and agree that, if I should c me s j ct t the workers' compensation provisions of Section
y00 of the Labor Code sh Ifo th mply with those provisions.
Date: vJ ✓ ' 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 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
fOnditinns and restrirtinn% cot fnrth nn thin nnplintlti0n.
1. Each person upon whose behalf this application is made, each person at whose request and for -
whose benefit wbrk 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 ab information ' orrect. I agree to comply with all
city and county ordinances and state laws. relating to buildin _J_
nstruction, a by authorize representatives
of thiso//(fity t enter upon the above-mentioned pr pert f r' s cti n put ses.
Date:`- Signature (Applicant or Agent): .
Application Number . . 07-00001096.
" Permit . . . . . . BUILDING PERMIT
Additional desc .
Permit Fee `. 108.00 Plan Check
Fee..
70.20
Issue,Date Valuation
_9000
Expiration•Date .10/16/07
Qty Unit Charge. Per
Extension
BASE FEE
45.00
7-00 1-,9.0000 THOU BLDG 2,001-25,000
-----------------------------------------------------------------------------
63.00
Permit ELEC-MISCELLANEOUS_.
Additional desc
Permit Fee 24.75 Plan Check
Fee
�6.19'
Issue Date Valuation
. . .
. 0
Expiration Date 10/16/07
Qty Unit Charge Per-
Extension
.BASE FEE
15.00
13.00 75'00 EA ELEC POLE LIGHT
9.75
Special Notes and Comments
13 SITE LIGHTING POLES, BASES &
ELECTRICAL, PER APPROVED PLANS. 2001
-CBC _2004 CEC:'
Other Fees . . . . . . ENERGY REVIEW FEE
7.02
STRONG MOTION .(SMI)
-'RES
.90
Fee summary_ Charged Paid Credited
Due
Permit Fee Total 132.75 .00
.00
132.75
Plan Check -Total 76.39 .00
.00
76.39
Other Fee Total - 7.92 .00
.00
7.92 ;
Grand Total 217.06 .00
.00
217.06
LQPERDIIT - ...