07-2448 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 07-00002448 Owner.
Property Address: 43100. PALM ROYALE DR WRM LA .QUINTA
APN:. 609.-051-010- - - 1000 E. 80TH PLACE
Application description: -WALL/FENCE MERRILLVILLE, IN 46410
Property Zoning: HIGH DENSITY RESIDENTIAL
Application .valuation: 10555
Applicant: Architect or Engineer:
n .
__________________________________________________
LICENSED CONTR OR'S DECLARATION
-I hereby affirm under penalty of perjury that a licensed u der provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busines an Profession Is de, and my License is in full force and effect.
License Cl ss/: 13 en a 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 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).:
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 willhave the burden of proving that he or she did not build or
improve for the purpose of sale.).' -
I— 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7naa, Rnrinarr and Prnfnrninnn 1796, Tho C un1ro818ra' 6t8t6 6166x66 LG.. J6& ( uyylq, iv un vcane, of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
I—) 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 (Seo. 3097, Civ. C.). ..
Lender's Name:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/31,/07
Contractor:
WPM CONSTRUCTION -CA LP
1000 EAST 80TH PLACE, #555 N..
MERRILLVILLE, IN 46410.
(219)680-5000.
Lic- No.: 825987
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WORKER'S COMPENSATION DECLARATION
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 TRUCK INS EXCHN Policy Number WC930464405
I certify that, in theperfor ce of the rk far which this permit is issued, I shall not employ any
person in any manners a to b@co a ubject to the workers' compensation laws of.California,,
and agree that, if I sho Id come bj c t the workers' compensation provisions of Section
�00 of the Labor C , I all f t ply with those provisions.
(-Date: 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
wnulduue ami iesuicuum set iurtn un tins 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 pursuantto 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 A.t,o�
or cessation of work for 180 days will subject
permit to cancellation. .
I certify that I have read this application and state thorman is «ect. I agree to comply with all
city and county ordinances and state laws relating touan er uthorize representatives
of thisco fy o enter upon the above-mentioned prcti n p p Date:' Signature (Applicant or Agent):
. Application Number 07-00002448
Permit WALL/FENCE
PERMIT
Additional desc .
Permit Fee 126.00
Plan Check
Fee
.00
Issue Date
Valuation
10555
Expiration Date 2/27/08
Qty Unit Charge Per
Extension
" BASE
FEE
45.00
9.00 9.0000 THOU BLDG
2,001-25,000
81.00
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Special Notes and Comments
-
-------
- -
1378 LF. WROUIGHT IRON FENCE AT
RETENTION BASINS.
Fee;summary Charged
Paid Credited
Due
Permit Fee Total 126.00
.00
.00
126.00
Plan Check Total. .00
.00
.00
.00
Grand Total "-126.00
00
.00
126.00'
LQPERMIT -
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