11-0408 (SPIN)P.O. BOX 1504- VOICE (760) 777-7012
78-495 CALLE TAMPICOFAX (760) 777-7011
LA,QUINTA,.CALIFORNIA 92253. BUILDING & SAFETY DEPARTMENT . INSPECTIONS (760) 7774153
BUILDING PERMIT
�^ Date: 4/21/11
Application' Number: 11-000004_0_8 -� Owner:
Property Address: `-47225 WASHINGTON ST ROMAN CATHOLIC BISHOP OF SB
APN:- 643-090-026-2 - -000000- 1201 E HIGHLAND AVE
Application description: SPECIAL INSPECTION SAN BERNARDINO, CA 92404
Property Zoning: LOW DENSITY RESIDENTIAL p
Application valuation: 2000. ; D
• j
Contractor: P 2011
Applicant: Architect or Engineer: CLASSIC PARTY RENTALS.
. CSLB, LIC-.NOTREQ' D. - GBD. - G_B_7 CiTYOF L AQE INTA
75060 MAYFAIR DR
PALM DESERT, CA 92211. rer��t'St:?�FPi -
LICENSED CONTRACTOR'S DECLARATION' WORKER'S COMPENSATION DECLARATION
I�hereby affirm under penalty of perjury that I am licensedunderprovisions 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: -
hereby affirm under penalty of perjury that I am exempt from. the Contractor's State.Llcense Law for the Carrier 3992 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 the workers' 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 subject to the workers' 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 Code, I shall forthwith comply with'those provisions.
that he or she is exempt therefrom 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)•: Date: Applicant:
(_) 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 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 ($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
(_) 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,
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'
performed under or following issuance of this permit.
Date: .Owner: 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 ••
CONSTRUCTION LENDING AGENCY permit to cancellation. •-�
I 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 informationis correct. I agree 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 construction, and hereby authorize representatives
of thi county to enter upon the above-mentioned property for ' pection pur es.
• Lender's Name: -
' ate: a Signature (Applicant or
.Lender's Address: - -
LQPERMIT
Application Number . . . 11700000408.
Permit SPECIAL INSPECTION
Additional.desc .
Permit'Fee . . . . 100.00 Plan Check
Fee'.
.00
Issue Date . . . Valuation
2000
Expiration Date 10/18/11
Qty Unit Charge Per
Extension'
BASE FEE
`100.00
Special Notes and Comments
SPECIAL INSPECTION FOR 20' X 50'
' TEMPORARY TENT TO BE. INSTALLED FOR.
EASTER SUNDAY SERVICES ON APRIL 24,
2011:' PER TUP # 2011-1031. 2010' CODES.
Fee summary Charged Paid Credited
Due
Permit Fee Total ."100.00.. .00
00.
100.0.0"
Plan Check Total .00 00
.00 ..
.00
Grand,Total 100.00 .00
00
100.00
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