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07-0354 (CCOM)O- BOX 1504 CALLE TAMPICO - .VLA QUINTA, CALIFORNIA 92253 Application Number: 07-00000354 Property Address: `43100 PALM ROYALE DR APN: 609-051-010- - - Application description: CARPORT - COMMERCIAL Property Zoning: _HIGH DENSITY RESIDENTIAL Applivadun vMuetiuii. 17317 Applicant: 'Architect or Engineer: 4.4 a" BUILDING & SAFETY DEPARTMENT ' BUILDING PERMIT A f VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: D WRM LA QUINTA 4 1000 E: 80TH PL. MERRILLVI.LLE, IN 46410 MAS 18 np Contractor. ��Nq �QWPM CONSTRUCTION -CA LP, �CF�l�pNT'4 = 1000 EAST 80TH PLACE, #555 N- MERRILLVILLE, IN 46410 (219)680-5000 Date: 3/14/07 LQPERMIT - - LiC No... 825987 ------------------------------------------------ - LICENSED CONTRACTOR'S DECLARATION - n -------------------------------------------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I 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 Professio als 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 Cl ss: B License.No.: 825987 - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is - J - issued..' Date: J.""C ,v 1. Contractor. _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performanceof the work. for which this permit is issued. My workers' compensation -- ' OWNER -BUILDER DECLARATION - -- insurance carrier and policy number ar: 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, priorto its issuance, also requires the applicant for the, - person in any manner so s to become 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 sho d ecome s 'ect to the 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 C e, shall fo 'th comply with those provisions. - that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by V 1 - any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1$500).: -"Date. G(Y Applicant: 1 _.) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and f 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 OFCOMPENSATION, 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 Coder 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 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 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 the ab 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 buildin c nstrut:tion d hereby authorize representatives - of this cou ty to nter upon the above-mentioned property or nspection .` Lender's Name: G �• - Date: ;/. (Applicant or Agent): Lender's Address:- - LQPERMIT - - y Application Number . . . . 07-00000354. ------ -Structure Information METAL CARPORT ----- Other struct info . . . CODE EDITION O1CBC04CEC - FLOOD ZONE NO GARAGE SQ FTG 1302.00 Permit . . . CARPORT/GARAGE Additional desc . Permit Fee. 189.00 Plan Check Fee 122.85 Issue Date Valuation 17317 Expiration Date 9/iU/UI Qty. Unit Charge Per Extension - BASE FEE 45.00 16;00 9.0000 THOU .BLDG 2,001-25,000 ---------------------------------------------------------------------------- 144.00 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 - 8 SPACES - 72.33FT X .18FT. S-3 OCCUPANCY, TYPE II -N CONSTRUCTION. 2001 CBC, 2004 CEC." [LOCATED E OF BLDG #121 - -------------------------------- Other Fees . . . . . . . .. ART IN PUBLIC PLACES -COM 66.58 STRONG MOTION (SMI) --COM, 3.63 Fee summary, Charged Paid Credited Due ---- ---------- ---------- Permit Fee Total 206.25. .00 .00 206.25 Plan Check Total 127.16 .00 .00 127.16 Other Fee Total 70.21 .00 00 70.21 Grand Total 403.62 .00 .00 403.62 LQPERMIT .