07-0999 (SPIN)f -
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
i
Application Number: COO0'0:0-09'9
Property Address: 47225 WASHINGTON ST
APN: 643-090-026.-2 000000 -
Application description: SPECIAL INSPECTION
Property Zoning: ..LOW DENSITY RESIDENTIAL
Application valuation: 100
Applicant: Architect or Engineer:
X11 U
t!'�itiGv
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT.
Owner:
ROMAN. CATHOLIC BISHOP OF SB
1201 E HIGHLAND AVE
SAN BERNARDINO, CA .92404
Contractor:.
-CLASSIC BUILDERS, INC -
45 -475 CLUB DRIVE
INDIAN WELLS, CA 92210
(760)772-1991
Lic. No.: 691405
VOICE.(760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/03/07
LICENSED CONTRACTOR'S DECLARATION
WORKER'SCOMPENSATION DECLARATION
I hereby 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: B - License No.: 691405
..
_
for by Section 3700 of the Labor Code,. for the performance of the work for. which this permit is
Date:. Contractor:
Ihissued.
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 EXEMPT Policy Number EXEMPT
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 the workers' compensation laws of California,
permit to file aisigned statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compens tion provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division S of the Business and Professions Code) or
700 of the Labor Code, s forthwith com (y -wit os a /ovi ons. -
and,
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
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any applicant for a permit subjects the to a civil penalty of not more than five hundred dollars 155001.:
D Q A cant:
(_ 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: FAIL E TO SECURE WORKERS' MPENSATION 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 CRIMINAL PE TIES 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 ($100,0001. 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 4 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 anypermit issued as a result of this application,
1 _ 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
Xgner:
performed under or following issuance of this permit.
.Date: •0
2. Any permit issued as a result of this application becomes nulland void if work is not commenced
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within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
' CONST TION LENDING AGENCY
permit to cancellation.
- Ihereby affirm under penalty of perjury that there is a struction lending agency for,the performance of the -
I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. .I. •-
city and cou ty ordinances and state laws relating to building c nstruction, and her y a tho ze representatives
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of this c u t e r upon th above-mentioned prop 'nspet. rpos -
Lender's Name:
Ci
e: V ature (Applicant or Agen 40f
Lender's Address:
LQPERMIT
Application. Number. 07-00000999.
'
'Permit SPECIAL INSPECTION• f
`
Additional desc •.
' Permit,Fee 10.0.00
Plan Check
-Fee..
.00
Issue Date
Valuation
100' ,
Expiration Date 9/30/07
Qty. Unit Charge. Per
Extension
BASE
FEE
100.00 ..
• •• -------.---------
Special Notes and Comments
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--------
-
-------- - -.- -- .. .
SPECIAL INSPECTION FOR 20' X 50'
TENT
:
TO BE INSTALLED.4/7/07 AND•TA'KEN
DOWN
`
•4/8/07,•PER.MUP# 07-908
Fed.summary Charged
• ':••--------r--------
.Paid,,, Credited
Due ,
--------=- --=-------
' Permit Fee Total 100.00
-- - - - - -
.00
- -----
.00
- - - - - --
100.00
Plan 'Check Total A0
.0"0
.00
.00
` Grand Total 100.00
.00
.00
100.00
I It
.l .. • '
-
LQPERMIT.•
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Bin #'
City of La.Quinta 1 ; ,w
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Building 8i Safety Divis r z
C, Sion .
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P O: "Box 1504,18-495 Calle Tampico; x
La'Qumta,•CA°92253 - (760j'777-7012
Permit #f;
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`. �" ` `Building
."
`Tracking
•� .
Permit Application and Sheet
Project Address: _ � 1 ` I
Owner's Name:
A. P. Number:
Address � �' S
. S
Legal ,Descriptign:. - + '
City,ST, Zip: ' ,� l'
(A. 9aa -3
Contractor:.
Telephone: a
Address':
Project Description "' i
City, ST, Zip: ,>. ' "� , ,.V
Telephone:4.
ti
State Lic. # .
. City Lica#:
" �• uJI. It -
M7
Arch., Engr., Designer - .-
'Address. N r r c r
c
City, ST, Zip:
Telephone: s. !'
p , { �
Construction Type: + " 7 Occupancy:
Project type (circle one): .,New . Add'n ' Alter'; Repair • be
State Lic. #:. '
r
Name of Contact Person:
'Sq. Ft.:'
#Stories.
#Units:
Telephone # of Contact,Person: o .$� / pOQ
.Estimated Value of Project.
'. APPLICANT: NOT BELOW LINE '
DO WRITE THIS x
#
Submittal
Req'dRecd
'TRACKING , �'
PERMIT FEES
Plan Sets t
-
Plan Checksubmitted,. ,
Item --
Amount
Structural Calcs.
Reviewed, ready for corrections {
Plan Deposit '
Truss Calcs.
Called'Contact Person
Plan Check Balance
"
Energy 'Calcs.
'4,
Plans picked up ;"r �°
Construchon>'
Flood plain plan.
Plans resubmitted' Jr .' f
Mechanical '
Grading.plan
2°" Review, ready for correchons/issue
Electrical
1
Subcontactor List
«+
Called Contact Person ' x .
,
A
Plumbing
Grant Deed
*
Plans picked,`up E,' ;
S.M.I. r
F
H.O.A. Approval'
'`
Plans resubmitted ,' °
Grading
Ft,.
INHOUSE:- T'
!
'"' Review ,_ready forcorrect}ons'hssue '. "
Developer Impact Fee
Planning Approval
!
'
Called.Contacf Person
A.I.P.P.
0
Pub. Wks. Appr
`
Date of permit issue
` r
School Fees
' ' %
`Total Permit Fees +"-