07-0346 (CCOM)• ' P.O. BOX 1504
78-495 CALL TAMPICO
LA QUINTA, CALIFORNIA 92253
ACplication Number: -~ 07-00_000346 1
^
Property Address:--. - -4"3100 PALM ROYALE DR
APN: '609 -051 -010 -
Application description: CARPORT - COMMERCIAL
Property Zoning: HIGH DENSITY RESIDENTI1
Application Valuation: 15162
Applicant: Architect, or
i4
u�l'�GiGv .
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjuryth 1 am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busin s and Prof ionals Code, and my License is in full force and effect.
License Cl ss: B License 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 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 intendedoroffered 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 1, 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 6 I am exempt under Sec. BAP.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
VOICE (760)'777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/14/07
Owner:
WRM LA QUINTA
100 E 80TH PL
MERRILLVILLE, IN 46410
Contractor:
WPM CONSTRUCTION -CA LP
1000 EAST 80TH PLACE, #555 N.
MERRILLVILLE, IN 46410
(219)680-5000
Lic. No.: 825987
---------------------------------------------
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 t0 b ome subject to the workers' compensation laws of California,
and agree that, if I should bec subjeMhthose
' compensation provisions of Section
370 of the Labor Code, I s It hw' provisions.
D ate: vii Applicant-. ti
t—
J
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 1$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 workis performed under or pursuant to any permit issued as 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 thea a informati i correct. I agree to comply with all
city and county ordinances and state laws relating to buildi onst�uCtio , an rebs authorize representatives
of this o /nty t �. {eJnter upon the above-mentioned prope fo i spection o S.
Date: _Signature (Applicant or Agent): _ -
_ i
a
T Application Number . . 07-00000346
Permit . . CARPORT/GARAGE
Additional desc".
Permit Fee . . . . 171.00. Plan Check Fee..
111.15
Issue Date . . . . Valuation. . . .
. 15162
Expiration Date 9/10/07
Qty Unit Charge Per -
Extension
BASE FEE %
45.00
14.00 9.0000 THOU BLDG 2,001=25,000
126.00 .
Permit . . . ELECTRICAL-CARPORT/GARAGE
Additional desc .
Permit Pee 1'8.00 Plan Check Fee
4.50
Issue Date Valuation
0
Expiration Date 9/10/07
Qty Unit Charge Per
Extension .
BASE FEE
15.00
4.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
3.00
--------------------------------------------
Special Notes and Comments
METAL CARPORT - 7 SPACES- 63.33FT X
18FT. S-3 OCCUPANCY, TYPE II -N
CONSTRUCTION. 2001 CBC, 2004 CEC.
[LOCATED SE OF BLDG #51
-------
-- ---------------------------------
Other
Other Fees . . - ; . . .- .ART IN -PUBLIC PLACES -COM -_
-----
55.81 _
STRONG MOTION (SMI) - COM_
3.18
Fee summary Charged Paid Credited
Due
----- - - - - ------ - - - - - - ----------
Permit Fee Total 189.00 .00 .00
.189.00 -
Plan Check Total 115..65 .00 .•.00
115.65
Other Fee Total. 58.99 .00 00
58.99
Grand Total .363.64 .00 .00
363.64
LQPERMIT
,