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08-0289 (SPIN)P.O. "BOX 1504 78-495 CALLE•TAMPICO LA QUINTA; CALIFORNIA 92253. BUILDING & SAFETY 'DEPARTMENT BUILDING PERMIT Application Number: 08-00000289 Property Address: " 47110 WASHINGTON ST STE 101 'APN: -643-200-999-A-03429'- Application description: SPECIAL' INSPECTION Property Zoning: COMMUNITY COMMERCIAL Application valuation: 500. Applicant: . Architect or Engineer: —W Owner: C ALEO BAT INVESTOR 77-900 AVE OF STATES D PALM DESERT, CA 9.2260q¢� (760)345-2626 !/ / Contractor: Owner VOICE (760)777-7012 . FAX (760) 777-7011 INSPECTIONS..(760) 777-7153 !A:A cF QU/NT _ n��_ A Date: 2/12/08 --------------------------------------7----------------------7----------------------------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION Ihereby affirm under penalty of perjury that I am 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 and Professionals 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 Class: License No.: for by Section 3700 of the Labor Code, for the performance of the work for which this permit is -' - - issued. ' Date: Contractor: _ 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 ' OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the _ Carrier - - - - - - - - - - - - - - - - - - - - - - -Policy Number 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 as to become subject to th orkers' 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 should become sub' ct to the r rs' 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 , shall r h c pl rth those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by / Q &pplica any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date: I�-O . (_ 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 WARNING: FAILURE TO SECURE WOR S' CO ENSATION COVERAGE IS UNLAWFUL, AND SHALL • Contractors' State License Law does not apply town owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINA 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 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 f _ 1 1, 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 town ownerof conditions and restrictions set forth on this application, - property who builds or improves thereon, and who contracts for the projects with a contractors) 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. , 8.&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. - Va Z-00 Date: --Own :- ' 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 CO RUCT N LENDING AGENCY permit to cancellation. 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 above information is correct. I ee to comply with all work for which this permit is issued (Sec. 3097, Civ. C.).• - city and county ordinances and state laws relating to building constructio , nd hereby orize representatives ' of this county to enter upon the above-mentioned prop or msp n S. Lender's Name: ' "Dater -12 ,Oa Signature (Applicant or Agent Lender's Address: LQPERMIT `. Application Number 08-00000289 - ,. Permit . . ... . . SPECIAL INSPECTION Additional desc . Permit-Fee 100.00 Plan Check Fee .00 ,. Issue Date Valuation 500 -Expiration Date 8/10/08 Qty Unit Charge `Per Extension BASE FEE _ 10.0..00 ,. Special Notes and Comments SPECIAL.INSPECTION FOR CHANGE OF OCCUPANCY FROM GROUP B TO A -3 Fee summary Charged Paid Credited Due Permit Fee Total 100.00 .00 .00 .100.00 Plan Check Total .00 .00 .00 .00 . Grand Total 100.00 .00 .00 100.00 Bin # City of La Quinta Building & Safety Division P.O. Box 1504, 78-495 Calle Tampico U Quinta, CA 92253,- (760) 777-7012 Building Permit Application and Tracking Sheet Permit # q D`� 2 Project Address: � � i,j� O Owner's Name: ✓ Ga .L-NJ.7S-,-O A. P. Number: Address: b/ p O Aj 0 0hF S 7-,A 1-0-S Legal Description: City, ST, Zip: / - C1? Contractor: ✓ CkS2!- Telephone: '71. a> 3 -Z6 Address: Project Description: City, ST, Zip: S t;GiQL lv-�eEgQ:Far=G Telephone:. City Lic. #:. cz?-WR =0 State Lic. # : Arch., Engr., Designer: Address: City, ST, Zip: . Telephone: State Lic. #: Name of Contact Person:/ W ^, Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: # Units: Telephone # of Contact-Person: P 60 3 Lf $-Z-,(; Z.,L Estimated Value of Project: ✓ APPLICANT: DO NOT WRITE BELOW THIS LINE . # Submittal Req'd - Rec'd TRACKING _ PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cities. Reviewed, ready for corrections Plan Check Deposit Truss Cities. Called Contact Person Plan Check Balance Energy Calcs. Plans picked up Construction Floodplain plan- Plans resubmitted Mechanical Grading. plan 2°" Review, ready for corrections/issue Electrical Subcontactor. List Called Contact Person Plumbing Grant'Deed Plans. picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE: '"' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Certificate of Occupancy p y oAl�-a-'""�c a G OFTiBuilding & Safety Department This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 47-110 WASHINGTON ST. STE #101 Use classification: "Episcopal Church of the Apostles" Building Permit No.: 08-289 Occupancy Group: A-3 MAX OCCUPANCT 195 Type of Construction: V_B Land Use Zone: CR Owner of Building: CALEO BAY INVESTORS Address: 77-900 AVE OF STATES City, ST, ZIP: PALM DESERT, CA 92260 By: STEVE TRAXEL ^� Date: FEBRUARY 22, 2008 Building Official POST IN A CONSPICUOUS PLACE