07-0349 (CCOM).P.O. BOX 1504.
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4
BUILDING &-SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS -(760) 777-7153
r--
Date: 3/14/07
Application Number- 07-00000349
Owner:
Property Address: 43100 PALM ROYALE DR
WRM LA QUINTA ,
APN: 609-051-010- - -
1000 E. 80TH PL.
Application description: CARPORT - COMMERCIAL
O MERRILLVILLE, IN 46410
Property Zoning: HIGH'DENSITY RESIDENTIAL
Applioation valuation: ?-S? F7
�
r
Contractor:
Applicant: Architect or Engineer: �QG
Q WPM CONSTRUCTION -CA LP
.py�
JJ►►
O 1000 EAST BOTH PLACE, #555 N. .
MERRILLVILLE, IN 46410
'.
(219)680-5000
Lic. No.: 82.5987
LICENSED CONTRACTOR'S DECLARATION
- WORKER's COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed 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 a Professionals 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 CIss: B cense No.: 825987
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
- e+t1 of
��
issued.
Date: ✓ vl Contractor: r
_ 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
_
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 mannef so as to come subject 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 be a subjec the workers' compensation provisions of Section
• License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
700 of the Labor Code, 1 s all rthwit c y with those provisions.
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).:
Date: ` Applicant: 1
1 _ 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 T0. 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
(_) 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 be this application is 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 _ 1 I 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
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 -
' - CONSTRUCTION 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 I have read this application and state that thea a 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 build; g c nstruction, d hereby authorize representatives
- -
Lender's Name:"`
-
of this cou ty to enter upon the above-mentioned propert or specti n p r
-r. - --- -- -- -
y1
�
-
Date: Signature (Applicant or Agent)!
Lender's Address:
LQPERMIT'
LQPERMIT " ,
Application Number. 07-00000349
.------ I Structure Information METAL CARPORT
----'-
Other struct info . . . . . CODE EDITION
O1CBC04CEC
FLOOD ZONE
NO
GARAGE SQ FTG
----------------------------------------------------------------------------
1140.00
Permit . . . CARPORT/GARAGE
Additional desc .
Permit Fee . . . . 171.00 Plan Check Fee
27.79
Issue Date . . . . Valuation
15162
Expiration Date 9/10/07
Qty Unit Charge Per
Extension
BASE FEE
45.00
14.00_. 9.000.0 THOU BLDG 2,001-25,.000
----------------------------------------------------------------------------
126.00
Permit ELECTRICAL-CARPORT/GARAGE
Additional desc .
Permit Fee . . . . 18.00 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 .750.0 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 E OF BLDG #21 REDUCED PC FEE
FOR DUPLICATE STRUCTURE.
--
- --------------------------------------
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 32.29 .00 .00
32.29
Other Fee Total 58.99 .00 .00
58.99
Grand Total 280.28 .00 .00
280.28
LQPERMIT " ,