07-1683 (PLBG)q,T • - .
,e
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 07-00001683 Owner:
Property Address: 54460 TANGLEWOOD. PETE GOW
APN: 775-051-048-- - - 54-460 TANGLEWOOD
Application description: PLUMBING LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 0
Contractor:
Applicant: Architect or Engineer:. ELITE SERVICE PLUMBING
79830 AMORA DR
LA QUINTA, CA 92253
(760)343-6259
LiC.'No.: 846514
LICENSED Obw"CTOR'S DECLARATION
I hereby affirm under penalty of perjury that I I' en d under provisions of Chapter 9 (commencing with
Section 70 1 Division 3 of. the Busines nd r ionals Code, and my License is in full force and effect. _
Licens CI s: C36 Lic • 846514
,�te: ak7 Contract
OWNER -BUILDER DECLARATION -
hereby affirm under penalty perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 , Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, d molish, or repair any, structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
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).:
1 _ 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
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
. 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.).
1 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Cnntmrrnrs' State License Law does not apply to an ownor of _
property who builds or improves thereon, and who contracts' for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.). '
(_) I am exempt under Sec. , B.&P.C. for this reason '
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
VOICE (760) 777-7012
FAX (760) 777-701.1
INSPECTIONS (760) 777-7153
Date: .6/08/07
------------------
WORKER'S COMPENSATION DECLARATION
hereby affirm -under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided'
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
_ I have and will maintain workers' compensation insurance, as iequired by Section 3700 of the Labor
Cude, for the performance of the work,tor which this permit is issued. My workers' compensation
insurance carrier and policy number are:
.Carrier EXEMPT Policy Nymber EXEMPT
0-J certify that, in the performance of the �kor ich this permit is issued, I shall not employ any
person in any manner so as to bec a t to the workers' compensationlaws of California,
d agree that, if I should beco s ' 'o a workers' compensation provisions of Section
Q
700 of the. Labor Code, I s f omply with those provisions.
ate: V ,/ Applicant:
WARNING: FAILURE TO SECU WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL _
SUBJECT AN EMPLOYER To RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000).. IN DDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE BOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is her made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set furth un this application.
1. Eachperson upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
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.
2. Any permit issued as a result of this application becomes null and vo' work ' not commenced
within 180 days from date of issuance of such permit, or cess. ' n of o for 180 days will subject
permit to cancellation.
1 certifAcounor
d this application and state thattheabove infor do c ect. I agree to comply with all
city aces and state laws relating tobuilding cons ctio ereby authorize representatives
offtthisupon the above-mentioned property r ' pect ses.
iDate:.gnature (Applicant or Age <
Application Number
07-00001683
Permit• . . . . .
PLUMBING
Additional desc .
Permit Fee
18.00
Plan Check.Fee
4:50
Issue Date
Valuation
0
Expiration Date
12/05/07
Qty Unit Charge
Per.
Extension
BASE
FEE
15.00
1.00 3.0000
EA PLB
GAS PIPE 1-4 OUTLETS
3.00
Fee summary Charged
Paid Credited.
Due
Permit Fee Total
18.00
.00 ..00•.
18.00
.
Plan Check Total
4.50
.00 .00
4.50
Grand Total
22.50'
.00 .00
22.50