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07-0350 (CCOM)BOX 1504, 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 r Application Number: Property Address: APN: Application description: Property Zoning: Appliootion 'doluotionl Applicant: 07 - 00000350 43100 PALM ROYALE DR 609-051-010- - CARPORT - COMMERCIAL HIGH DENSITY RESIDENTIAL 151G8 Ti,4t �W BUILDING &. SAFETY DEPARTMENT' Architect or Engineer: LICENSED CONTRACTOR'S DECLARATION tfARABUILDING PERMITOwner: WRM LA QUINTA 1000 E. 80TH PL 16 MERRILLVILLE, IN 46410 - I hereby affirm under penalty of perjury that I m licensed under provisions of Chapter,9 (commencing with Section 7000) of Division 3 of the Business Professio Is Code, and my License is in full force and effect. License CI ss: B c– a No.: 825987 •Date: ;�Q - Contractor: i 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 (55001.: 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 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.). r I—) I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY 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 Contractor: WPM CONSTRUCTION -CA LP 1000 EAST BOTH PLACE, #555 N. MERRILLVILLE, IN 46410 (219)680-5000 Lic. No.: 825987 WORKER'S COMPENSATION DECLARATION Date: 3/14/07 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 f the work for which this permit is issued, I shall not employ any person in any manner so as o ecome subject to the workers' compensation laws of California, and agree that, if I should ec me subje t o the workers' compensation provisions of Section TI DO of the Labor Code, s ortwi with those provisions. Date:Applicant: 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 ($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 180 days will subject permit to cancellation. I certify that I have read this application and state that the abo nformation ' correct. I agree to comply with all city and county ordinances and state laws relating to building o struction, hereby authorize representatives of this coun to gnter upon the above-mentioned prop e y f r i ion 1 Date: t Signature (Applicant or Agent): Application Number 07-00000350 ------ Structure Information METAL CARPORT ------ Other.struct"info CODE EDITION 01CBC04CEC FLOOD ZONE NO GARAGE SQ FTG 1140.00 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 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 -" 7 SPACES- 63.33FT X 18FT. S-3 OCCUPANCY, TYPE II -N CONSTRUCTION. 2001 CBC, 2004 CEC. [LOCATED W OF BLDG #171 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 188.25 .00 .. .00 188.25 Plan Check Total "115.46 .00 .00 115.46 Other Fee Total 58.99 .00 .00 58.99 Grand Total 362.70 .00 .00 362.70 LQPERMIT .