06-2197 (PLBG)Ij
4P.
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
06-00002197
Owner:
Property 'Address:
55375 TANGLEWOOD
STEVE SOURAPAS
APN:
775-152-021- - -. -
55375 TANGLEWOOD
Application description:
PLUMBING
LA QUINTA, CA 922
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
300
Contractor:
Applicant:
Architect or Engineer:
HORIUCHI LANDS CICC
PO BOX '1324
CATHEDRAL CITY,
(760)324-8675
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 en full force and effect.
License Cla s: C27 License No.: 6054 +
Date: f 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 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 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.). _
am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 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) 777-7011
INSPECTIONS (760) 777-7153
'D,
DiC�AY 3 2006
9 21 . _
WORKER'S COMPENSATION DECLARATION
Date: 5/30/06
hereby affirm under penalty of perjury one of the following declarations:
Ihave andwillmaintain 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 3700 of the Labor.
Code, for the performanceof the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier EXEMPT Policy Number EXEMPT
W 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 prov' ' ns of Section
37 O ofthe Labor Code, I shall fo ith comply with those provisions. -
Datey�{f'aplicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
'SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANDCIVILFINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION 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. I
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
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 hereby authorize representatives
of this count /t�o den/t/ r upon the above-mentioned propert1Y. for inspe on purposes.
Date4CZ�'"�^'�"•4%�nature (Applicant or Agent): 1 �
Application Number 06-00002197
Permit . . . PLUMBING
desc .
_Additional
Permit Fee 18.00
Plan
Check Fee
.00
Issue Date . . ...
Valuation.
0
Expiration Date 11/26/06
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
25 LF'3/4" GAS LINE TO EXISTING,
RELOCATED BBQ:
Fee summary Charged
Paid
Credited
Due
-- ----
Permit Fee Total. 18.00
-- - - - - ---
.00
--- - -- ----
.00
--- -- ----
18.00
Plan Check Total .00
.00
.00
.00
Grand Total 18.00
.00
.00
18.00'
i
LQPERMIT
Bin #
City of La Quinia
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampito
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and. Tracking Sheet
Permitfl
Project Address:'
A. P. Number:
Legal Description:
Contractor: 'r_Df 14C1 N S P
Owner's Name:
Address:)%S_PS 25
City, ST, Zip: f ZZ 33
Telephone 2OL
Address:2 1 g, '
City, ST, Zip:C e 7-.Z3
Project Description: S t^
Telepho _ 6
o 2 d e�
State Lie. # :COI 8. `J qCrityLi.c. #:6 --1c7A $3
Arch., Engn, Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: 30G
APPLICANT:
DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACEING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked 'up '
Construction
Flood plain 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:-
7n° Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School.Fees.
Total Permit Fees