07-0371 (CCOM)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN: .
Application description
Property Zoning:
Application valuation:
Applicant:
07-00000371,
--43100 PALM ROYALE DR
609-051-010- - -
CARPORT - COMMERCIAL
HIGH DENSITY RESIDENTIAL
19232.
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
D WRM LA-QUINTA
G 1000 E. 80TH PL..
n MERRILLVILLE, IN 46410
AMR
*%i.-16 ?®OI
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
ontractor:
PM CONSTRUCTION -CA LP'
1000 EAST 80TH PLACE, #555 N.
MERRILLVILLE, IN 46410
(219)680-5000
L'ic. No.: 825987
Date: 3/14/07
• LICENSED CONTRACTOR'S DECLARATION
--------------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I a 'tensed 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 an P fessional ode, 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 a s: B No.: •825987
!Date: VW
for by Section 3700 of the Labor.Code, for.the performance of the work for which this permit is
issued.
_ Contractor:
I have and will maintain workers' compensation insurance, as -required bySection 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•1 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 manner so a o become subj t to the workers' compensation laws of California,
ti
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 a ome subject workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
/7 3,900 of the Labor Code I s f h ith mpl i h those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
'a
'Cn -
y 1 -
any applicant for a permit subjects the applicant tocivil penalty of not more than five hundred dollars ($500).:D
ate: t Applicant:
(_) I, as owner of the property, or my employees with'wages as their sole compensation, will do the work,'and
1— /
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 1$100,0001 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
1 _ 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 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 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,
I—) I am exempt under Sec. , BAP.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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:
LQPERMIT
o La umta, its o kers, 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 a o e information is cor ct. I agree to comply with all
city and county ordinances and state laws relating to buildi _
_
.
,
ruction, d r authorize representatives
of this county t enter upon the above-mentioned prope , or in a ti pu ses
Date: r /uSignature (Applicant or Agent): r
Application Number 07-00000371
------`- Structure Information METAL'CARPORT
---=-
Other. struct info . CODE EDITION
01CBC04CEC
FLOOD ZONE
NO
GARAGE SQ FTG
1446.00
Permit CARPORT/GARAGE
Additional desc .
Permit Fee . . . 207.00 Plan Check Fee
33.64
Tssue Date Valuation . .
.. 19232
Expiration Date y%lU%U'I
Qty .Unit Charge Per.
Extension
BASE FEE
45.00
18.00 9.0000 THOU BLDG 2,001-25,000
-----------------------------------------------------------------------------
162.00,"
Permit . . . ELECTRICAL-CARPORT/GARAGE
Additional desc .
"Permit Fee . . . . 18.75 Plan Check Fee
4.69
Issue Date . . . Valuation . . .
0
Expiration Date 9/.10/07
Qty Unit Charge Per
Extension
BASE FEE
15'.00
5.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
3.75
-------------------------------------------
Special Notes and Comments
METAL CARPORT (9'SPACES [7REG + T HC "+ 1
-
ACCESS AISLE])80.33FT X 18FT S-3
" OCCUPANCY, TYPE II -N CONSTRUCTION 2001
CBC 2004 CEC:[LOCATED W OF BLDG
#3]REDUCED"PC.FEE DUE TO MULTIPLE
STRUCTURE.
Other Fees . . . . . . . ART IN PUBLIC PLACES -COM
76.16.
STRONG.MOTION (SMI) -,COM
4..03
Fee summary Charged Paid Credited
Due
------- ---------- ----------
Permit Fee Total .225.75 .00- .00
225.75
Plan Check Total 38.33 .00 .00
38.33
Other Fee -Total 80.19 .00 .00
80.19
Grand'Total 344.27 .00 .00
344.27
LQPERMIT