06-2583 (CGAR)�1
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
pp!i: ation. iluation:
,,M?6=0_CF0 0.25.8.3
43100 PALM ROYALE DR
609-051-010- - -
GARAGE - COMMERCIAL
HIGH DENSITY RESIDENTIAL
46741
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT .
Applicant: Architect or Engineer:'
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury tAt I am lice sed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busi and Prof sionals Code, and my License is in full force and effect.
License class: B LicenseNo.: 825987
Date�t 4 �� 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, 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.
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 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:
LQPERMIT
Owner: `
DUTCH PARENT NV
38 NEWBURY ST 6TH FL
BOSTON, MA 2116
VOICE (760) ,777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/30/06
Contractor:
WPM CONSTRUCTION -CA LP D d
1000 EAST 80TH PLACE, #555
. MERRILLVILLE, IN 46410
(219) 680-5000 DEC 04 1006
Lic. No.: 825987
` Cid,
R,N OF
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 shou become sub',�ct to the workers compensation provisions of Section -
t�14l�L 00 of the Labor Co shall ;orth i omply with those provisions.
.-Date: —Applica—nt: '
-'�WAINING: FAAILURE'TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS is 1oo,0001. 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 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 th bove information is correct. I agree to comply with all
city and county ordinances and state laws relating to bui i g constru ion, nd hereby authorize representatives
of this counts to enter upon the above-mentioned pro pe
y r inspe oses.
fDa�2 /�� Signature-(Appli� or Agent):
Application Number. 06-00002583
------ Structure Information DETACHED GARAGE
-----
cr Other struct.info . . CODE EDITION
2001 CBC
FIRE SPRINKLERS
NO
FLOOD ZONE
NO
r.., GARAGE SQ FTG
---------------------------------- ---------------------------------------------
1470.00
Permit . . . CARPORT/GARAGE
Additional desc DETACHED GARAGE W/ ACCESS. SP
Permit Fee i F,7 nn P1 an rhprk. PPP
'174 '7A
Issue Date . . . . Valuation
85701
Expiration Date 5/29/07
Qty Unit.Charge Per
Extension
BASE FEE
.00
36.00 4.5000 THOU BLDG 50,001-100,000
----------------------------------------------------------------------------.
162.00
Permit . ... ELECTRICAL-CARPORT/GARAGE
Additional desc .
Permit Fee . . 44.40 Plan Check Fee
11.10
Issue Date Valuation
0
Expiration Date 5/29/07
Qty Unit Charge Per
Extension
BASE .FEE
15.00
1470.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 29.40
Permit' . . GRADING PERMIT
Additional desc .
Permit Fee . . . 15.00 Plan Check Fee
.00,
Issue Date Valuation
0
Expiration Date 5/29/07
Qty Unit Charge Per
Extension
BASE FEE
15.00
-------------
Special Notes and Comments.•
FOUNDATION PERMIT ONLY FOR DETACHED
GARAGE (5 + 1 Access. sp) 20'-7" X
71'-511(1470 SF)S-3,OCC. TYPE V -N
CONSTRUCTION.2001 CBC,2004 CEC.
Other Fees . . . . . . . . ART IN PUBLIC PLACES -COM
408.50
DIF CIVIC CENTER - COMM
229.31
DIF FIRE PROTECTION -COMM
66.15
LQPERiA1IT
Application Number
.. . . . .
06-00002583
-----------------.--------------------------
Other Fees .
. .
---------
STRONG MOTION (SMI) - COM
----------
17.99
DIF STREET MAINT FAC-COMM
155.81
DIF TRANSPORTATION - COMM
3869.03
Fee .summary
Charged
Paid Credited
Due
Permit Fee Total
221.40.
.00 .00
221.40
Plan Check Total
385.83
00 .00
385.83
Other Fee Total
4746.79
.00 .00
-4746.79
rranrl. Tntal
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