07-0345 (CCOM). " P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
/_-A" li—ion Number: 07-00000345(
`Property Address: _ '43100 PALM ROYALE DR
APN: 609 -051 -010 -
Application description: CARPORT - COMMERCIAL
Property Zoning: HIGH DENSITY RESIDENTIA
Appliootion valuation: 131`107 '
Applicant: Architect or I
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/14/07
Owner.
WRM-LA QUINTA
43-100 PALM ROYALE
LA QUINTA, CA 92253
Contractor:
WPM CONSTRUCTION -CA LP
1000 EAST 80TH PLACE, #555 N.
MERRILLVILLE, IN.46410
.(219)680-5000 '
Lic. No.:,825987
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am 'censed under provisions of Chapter 9 (commencing with _
I hereby affirm under penalty of perjury one of the following declarations: '
.. Section 7000) of Division 3 of the Business an P ofessional Code, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
_ License ass: LB ense No.: 825987
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
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Date: '- Ie .f/ ' 'Contactor: r
issued.
- _ I have and will maintain workers' compensation insurance, as required by Section i700 of the Labor
c - - _ . -
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_ _. Code, for the performance of the work for which this permit is issued.. My, workers' compensation
OWNER -BUILDER DECLARATION
insurance carrier and policy number are: - -- - ..-
I hereby affirm under penalty of perjury that I am exempt from the.Contractor's State License Law for the
Carrier, ZURICH AMERICAN Policy Number WC930464404 _
following reason (Sec: 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
. construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so a become 'ect to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should a me subje o t e workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Cod s II o w' om with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
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any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date: v Applicant:
(_ 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
WARNING: FAILURE TO -SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
• Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND '
. and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
APPLICANT ACKNOWLEDGEMENT
• (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is.hereby made to the Director of Building. and Safety for a permit subject to the
' 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth'on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1 . Each person upon whose behalf this applicationis made, each person at whose request and for
pursuant to the Contractors' State License Law.). - -
whose benefit work is performed under or pursuant to any, permit issued as a result of this. application,
' (_) 1 am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold .harmless the City ,
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`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. ,.
Date: Owner: -
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
• CONSTRUCTIONS LENDING AGENCY
permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that) have read this application and state that the Ove information is correct. I agree to comply with all
work for which. this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and state laws relating to buil constru do ,and hereby authorize representatives
_
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of this c ty t enter upon the above-mentioned prop rise io ses. t
Lender's Name: ' -•
- -
I �- -
:,Date: signature (Applicant or Agent):
Lender's Address: • -�-�.-
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LQPERMIT •
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Application Number 07-00000345
------ Structure Information. METAL CARPORT
-----
Other struct info CODE EDITION
2001CBC.04 CEC
FLOOD ZONE
NO
GARAGE SQ FTG
978.00
Permit . . . . . CARPORT/GARAGE.
Additional desc
Permit Fee, . . 153.00 Plan Check Fee
24.86
Issue Date Valuation
13007
Expiration Date 9/10/07
Qty Unit Charge Per
Extension
BASE -FEE
45.00 .
12.00 9.0000 THOU BLDG 2,001-25,'000
108.00
Permit ELECTRICAL-CARPORT/GARAGE
Additional desc .
Permit Fee . . . 17.25 Plan Check Fee
4.31
Issue Date . . . '. Valuation
0
Expiration Date . 9/10/07
Qty Unit Charge Per
Extension
BASE FEE
15.00
3.00 .7500 PER ELEC DEVICE/FIXTURE '1ST 20
2.25.
- Special Notes and Comments
---------
METAL CARPORT - 6 SPACES (INCL. 1
-
" ACCESSIBLE STALL) - 54.33FT X
18FT. S-3 OCCUPANCY, TYPE II -N
CONSTRUCTION. 2001 CBC, 2004 CEC..
(LOCATED N OF BLDG #4] REDUCED PC -FEE
FOR DUPLICATE STRUCTURE.
-Other Fees ART IN PUBLIC PLACES -COM
----------
45.03
STRONG MOTION (SMI) - COM
2.73
Fee summary Charged Paid Credited
---------------
Due
-- ---------- ---------- ---------- ----------
Permit Fee Total 170.25 .00 .00
170.25
Plan Check Total 29.17 .00 .00
29.17
Other Fee Total 47:76 .00 .00
47.76
Grand Total 247.18 .00 .00
247.18
' LQPERMIT
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