06-4139 (CGAR)4
P.O. BOX 1504
78-495 CALLE.TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
MO. 6 00004139
43100 PALM ROYALE DR
609-051-010- - -
GARAGE - COMMERCIAL
HIGH DENSITY RESIDENTIAL
81853
Architect or Engineer:
aF�4�w
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
LICENSED'CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busin sand Profe sionaI Code, and my License is in full force and effect.
License Class: 13 ' LicenseNo.: 825987
Dae 1 4 0 'ontract
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 fbr 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:
LQPEIL\IIT
Owner:.
DUTCH -PARENT NV
38 NEWBURY ST 6TH FL
BOSTON, MA 2116
Contractor:
WPM•CONSTRUCTION-CA
1000 EAST 80TH PLACE
MERRILLVILLE, IN 464
(219)680-5000
LiC. No.: 825987
VOICE (760) 777-7012
FAX (760) 777 -7011 -
INSPECTIONS (760) 777-7153
Date: 11/30/06
D 555 a.
DEC (0 4 2005
CITY OF LA QUINTA
FINANCE DEPT.
------------------
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 Numtier 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 s s to become subject to the workers' compensation laws of California,
and agree that, if I sho I become subject to the workers' compensation provisions,of Section
33700 of the Labor C e, I shag f th comply with those provisions.
�Datel144144 /Applicant: '
WARNiNG: FAIL RE 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
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 1 80days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to buildif constructi , and hereby authorize representatives
of this county to enter upon the above-mentioned proper r inspec ' rposes.
'."nature (AP-6licant_orr Agent):
LQPERDiIT .
Application Number. 06-00004139
------ Structure Information DETACHED GARAGE
-----
Other struct 'info .'. CODE EDITION
2001,CBC
FIRE SPRINKLERS
NO
FLOOD ZONE
NO
GARAGE SQ FTG
1404.00
Permit . .CARPORT/GARAGE
Additional desc DETACHED GARAGE
Permit „Fee . . 55U.54. plan Check FQQ
.. 363.03
Issue Date Valuation . .
. . 81853
Expiration Date 5/29/07
Qty Unit Charge Per
Extension
BASE FEE'
414.50
32.00 4.5000 THOU BLDG 50,001-100,000
----------------------------------------------------------------------------
144.00
N Permit . . ELECTRICAL-CARPORT/GARAGE
Additional.desc .
Permit'Fee 43.08 Plan Check Fee
10.77
Issue.Date . . . . Valuation . .
. . 0
Expiration Date 5/29/07
Qty Unit Charge Per
Extension
BASE FEE
15.00
1404.00 0200 ELEC GARAGE OR NON-RESIDENTIAL 28.08
- _
---------------------------------------------------------------------- - - ---- - -
Permit . . GRADING PERMIT
Add"tional.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 20'-7" X 68'-411(1404 SF)
S-3 OCC. TYPE V -N CONSTRUCTION.2001
CBC,2004 CEC.
Other Fees .." . . . . . .' ART IN PUBLIC PLACES -COM
389.26
^ DIF CIVIC CENTER - COMM
-219.02
DIF FIRE PROTECTION -COMM
63.18
LQPERDiIT .
Application Number
. . . .
06-000.04139
-------------------
Other Fees
. . . . . .
STRONG MOTION (SMI) - COM
17.18
DIF STREET MAINT FAC -COMM
148.82
DIF TRANSPORTATION - COMM
3695.32 -
Fee summary..
Charged
Paid Credited
Due
Permit Fee Total
616.58
.00 .00
616.58"
Plan Check Total
373.80
.00 .00
373.80 .
Other Fee Total
4532.78
.00 .00
4532.78.
Crand Total
5FM.16
:00 .00
5523.16
L1 .
LQPERDIIT _
,