07-0363 (CCOM)P.O. BOX 1,504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4 Application Number: 07-00000363.`
Property Address: 43100 PALM ROYALE DR
APN: 609-051-010- - -
Application description: CARPORT - COMMERCIAL
Property Zoning: HIGH DENSITY RESIDENTIAL
Ii,ppliootien voluotionl 9459
TWif. 4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
MAR 162007 -I)
Clay pv
Applicant: Architect or Engineer: nN_ANCEDEA'
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that am licensed under provisions of Chapter 9 (commencing with
• Section 7000) of Division 3 of the Busine rid Profess' rials Code, and my License is in full force and effect.
License Cl S: B icense No.: 825987
Date:--�-F-� 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 isexempttherefrom 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 1, 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.).
(_ I 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.).
I—) I am exempt under Sec. B.&P.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:
r
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/14/07
Owner:. ,
WRM LA-QUINTA
000 E. 80TH PL.
IERRILLVILLE, 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 marine as becomes bject to the workers' compensation laws of California,
and agree that, if I should a ome'subj to the workers' compensation provisions of Section
00 of the Labor Cod s all f r�iw c ply with those provisions.
(/ t
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 1$100,0001. 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'herebymade 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 information is correct. I agree to comply with all
city and county ordinances and state laws relating to buildin c nstruotjon, d ereby authorize representatives
of this coun) to a ger upon the above-mentioned propert or spe tion u
Dale: � i
ergnature (Applicant or Agent): "
Application Number. 07-00000363
---.--- Structure Information METAL CARPORT
-----
Other struct info . . . CODE EDITION
01CBC04CEC
'FLOOD ZONE
NO
GARAGE SQ.FTG
636.00
Permit. . . . . . CARPORT/GARAGE
Additional desc.. -
Permit: Fee 108.00. Plan Check Fee
70.20
TSB11P. Date Valuation
8459
Expiration Date 9/10)07
Qty Unit Charge Per
Extension
BASE FEE
45.00'
-7.•00, 9.0000 THOU BLDG 2,001`25,000
63.00
Permit ELECTRICAL-CARPORT/GARAGE
Additional desc .
Permit Fee 16.50 Plan Check Fee
4.13
Issue Date . . . . Valuation
0
Expiration Date 9/10/07
Qty Unit Charge Per
Extension
BASE FEE
15100
2.00 ..7500 PER ELEC DEVICE/FIXTURE 1ST 2.0
1.50
- Special Notes and Comments _•.
_
METAL CARPORT (4 SPACES [2REG +1 HC + 1
ACCESS AISLE]) 35.33FT X 18FT S-3
_
OCCUPANCY, TYPE II-N CONSTRUCTION 2001
CBC 2004 CEC.[LOCATED N OF BLDG #151.
Other Fees . . . .. . . . ART IN PUBLIC PLACES-COM
22.29
STRONG MOTION (SMI) - COM
1.77
Fee summary Charged Paid Credited
Due
Permit'Fee Total 124.50 .00 .00
124.50
Plan Check Total 74.33 .00 .00
74.33'
Other Fee Total 24.06 .00 .00
24.06
Grand Total, .222.89 .00 .00
222.89
LQPERMIT -
_