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
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