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
.