07-0666 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning: '
Application valuation:-
(07-00000666
55156 TANGLEWOOD
775 -154 -005 -
PLUMBING
LOW DENSITY RESIDENTIAL
400
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/02/07
Owner:
Mr. Ken Northrup
55156 tan-'A.r�r,ra
LA QUINTA
Contractor:
Applicant: Architect or Engineer: HORIUCHI
PO BOX 13
CATHEDRAL
(760)324-
Lic. No.: 605489
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under'provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.'
License Class: f27 License No.: 605 9.
� c
Date �. Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that -requires a permit to
construct, alter, improve, demolish, or repair any structure, prior. to its issuance, also requires the applicant for the
permit to file a signed statementthat 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 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
Y improvements are not intended or offered for sale. If, however, the building or improvement is sold within
brie 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.).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (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 contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.). '
(_ 1 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
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 required by Section 3706 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier EXEMPT Policy Number EXEMPT
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation ovisions of Section
0 of the Labor Code, 1 shall forth th c mply with those Provisio
-Date: Q Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
• DOLLARS ($100,000).' IMADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. .'
APPLICANT ACKNOWLEDGEMENT .
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1 . Each person 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 void if work is notcommenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify, that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction and hereb authorize representatives
of this cou ty t enter upon the above-mentioned property for inspect urpos s.
'Date: ignature (Applicant or Agent):
Application Number . . . . . .07-00000666
Permit- :: `• PLUMBING .
Additional desc .
Permit Fee 18.00 Plan
Check Fee
4.50 _.
Issue Date'. .. Valuation
0
Expiration Date 8/29/07.
Qty Unit Charge Per
Extension
BASE -FEE
15.00
1.00 3.0000 EA PLB GAS PIPE 1-4
OUTLETS :
3.00
---------------------------------
Special Notes -and Comments
" RUN 3/411 -GAS LINE FROM STUBOUT @ SFD TO
FUTURE APPROVED APPLIANCE(BBQ) iF BBQ
TO BE CONSTRUCTED ON-SITE, AN
ADDITIONAL PERMIT IS REQUIRED.
Fee summary Charged Paid
Credited
Due
Permit Fee Total 18.00 .00
.00
1-8..00
Plan Check Total 4.50 .00
.00'
4.50'
Grand Total 22.50 .00
'.00
. 22.50
LQPERMIT
Bin #
Permit #
Project Address:'
A. P. Number:
Contractor: � t
Address: _ 1>'2-1
City, ST, Zip:C' colIr
Telephone:
State Lie. #
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person:
Telephone #9f Contact Person:
# Submittal 1
Plan Sets
Structural Cate.
Truss Cale.
Energy Cale.
Flood plain plan
Grading. plin'
Subcoutactor List .
Grant Deed
H.O.A. Approval
IN HOUSE-
Planning Approval
Pub. Wks. Appr
School Fees
City Of La Quinta,
Building U, Safety Division
P.O. BOX 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name:
Address:
N
City, ST, Zip: p 4 C
Telephone: 7 6 0
Project Description:
Lic. #:
Total Permit Fees
Construction Type:
Occupancy:
�jc type (circle one):
New Add'n Alter Repair Demo
Sq. Ft :
# Stories:
#Units:
Estimated Value of Proj
1,
APPLICANT:
DO NOT WRITE BELOW THIS
UNE
TRACKING ,
.
PERMIT FEES
Plan Check submitted
Item
Amount .
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans Picked up
Coastncttoa
Plans resubmitted
Mechanical
2'' Review, ready for correctio- - Isue
Electrical
Called Contact Person
Plumbing
Plans picked up
SALL
Plans resubmitted
Grading
Review, ready for.corrections/issue
Developer Impact Fee
Called Contact Person
A.I.P.P.
.Date of permit issue
Total Permit Fees