BPLB2016-0073a _
auutrw -�
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BPLB2016-0073 Owner:
Property Address: 44565 MILAGO'DR ROBERT DIAMOND
APN: 604261003 44565 milago
Application Description: REMOVE & REPLACE 40 GALLON N/G la quinta, ca 92253
Property Zoning:
Application Valuation: $900.00
Applicant:
STATEWIDE SERVICES INC DBA STATE WIDE PL
36947 COOK ST STE 104
PALM DESERT, CA 92211%'.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C36. A. C33, C10 License No.: 936147
Date:
Contractor:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/23/2016
Contractor:
'STATEWIDE SERVICES INC DBA STATE WIDE PL
36947 COOK ST STE 104
1-:;P4M DESERT,.CA.92211
(442)666-8858
Llc. No.: 936147
WORKER'S COMPENSATION DECLARATION
I 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 3700 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:
OWNER -BUILDER DECLARATION
Carrier:- Polity Number: _
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
I certify that in the performance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
shall not employ any person in any manner so as to become subject to the workers'
city or county that requires a permit to construct, alter, improve, demolish, or repair
compensation laws of California, and agree that, if I should become subject to the
any structure, prior to its issuance, also requires the applicant for the permit to file a
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
signed statement that he or she is licensed pursuant to the provisions of the
comply with those provisions.
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
Date: Applicant:
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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
($500).:
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
(_) I, as owner of the property, or my employees with wages as their sole
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
compensation, will do the work, and the structure is not intended or offered for sale.
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
are not intended or offered for sale. If, however, the building or improvement is sold
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
within one year of completion, the owner -builder will have the burden of proving that
the conditions and restrictions set forth on this application.
he or she did not build or improve for the purpose of sale.).
1. Each person upon whose behalf this application is made, each person at whose
(_) I, as owner of the property, am exclusively contracting with licensed contractors
request and for whose benefit work is performed under or pursuant to any permit
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
issued as a result of this application , the owner, and the applicant, each agrees to, and
State License Law does not apply to an owner of property who builds or improves
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
employees for any act or omission related to the work being performed under or
the Contractors' State License Law.).
following issuance of this permit.
(� I am exempt under Sec. B.&P.C. for this reason
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.
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
Lender's Address
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 city to enter upon the
above-mentioned property for inspection purposes. .
Date: Signature (Applicant or Agent):
•
FINANCIAL INFORMATION
DESCRIPTION'
,AMOUNT" X PAID !PAID �'DATE :
a
t
BSAS SB1473 FEE
101-0000-20306 0 $1.00
$1.00 5/23/16
PAID BYMETHOD
°+� •RECEIP;T #"
HECK # ' Y t:, CLTD BYE.:
tricia mora
CREDIT WEB815
2016052039167094316 ECON
.
.Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00
'DESCRIPTION 1
, ACCOUNTS ".,�
QTY
ra gAMOUNT'.'�
'`
PAID DATE.
_PAID
Credit Card Fee
101-0000-43505
0
$2.47
$2.47
5/23/16
` aPAID BY,t '' „"; '
`°_ 'METHOD
RECEIPT ,# ``I >`
'; ;CHECK #
=CLTD BY,
tricia mora
CREDIT
WEB815
2016052039167094316
ECON
Total Paid for Credit Card Fee: $2.4.7 $2.47
.x DESCRIPTION �
;ACCOUNT,'
QTY :
- .
='AMOUNT.. "
PAID
PAID DATE
PERMIT ISSUANCE
101=0000-42404
0
$91.85
$91.85
5/23/16
a
.. ;PAID BY, .::A �~
METHOD %
RECEIPT #
CHECK #
CLTD BY -
tricia mora
CREDIT
WEB815
2016052039167094316
ECON
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
DESCRIPTION �s
�' ACCOUNTb
=QTY
AMOUNT`
s °
PAID, _
PAID'DATE
k
WATER HEATER/VENT
101-0000-42401
0
$12.09
$12.09
5/23/16
PAID BY �+
!x^ MET HOD''RECEIPT
#
&CHECK #
CLTD BY
tricia mora
CREDIT
WEB815
2016052317094316
ECON
096
�• DESCRIPTION _
ACCOUNT ..
QTY',
Q
AMOUNT
x
PAIOes
_
PAID DATE'
WATER HEATER/VENT PC
101-0000=42600
0
$7.25
$7.25
5/23/16
+ .p PAID BY
E.
°. METHOD "`
RECEIPT ,#,
CHECK #
CLTD BY
tricia mora
CREDIT
WEB815
2016052317094316096
ECON
Total Paid for PLUMBING FEES: $19.34 $19.34
TOTALS:
•
Description: REMOVE & REPLACE 40 GALLON N/G
CONTACTS
Type: PLUMBING -'WATER HEATER Subtype:
Status: ISSUED
Applied: 5/23/2016 ECON
CHANGEOUT (WEB)
- -
NAME TYPE
Approved.: 5/23/2016 ECON
Parcel No' 604261003 Site Address: 44565 MILAGO DR LA QUINTA,CA 92253
Subdivision: TR 23913 Block:
*Lot: 42
Issued: 5/23/2016 ECON
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $900.00 Occupancy Type:
Construction Type:
Expired: 11/19/2016 ECON
No. Buildings: 0 No. Stories: 0
No. Unites: 0
STATEWIDEPLUMBING
Details:
WIDE PL
FINANCIAL INFORMATION
Printed: Thursday, lune 23, 2016 9:41:28 AM 1 of 3 1
• sysrcMs
CONTACTS
- -
NAME TYPE
'," "; ,a NAME; r
r,•_.
ADDRESSI CITY
STATE
ZIP -
`PHONE FAX,
EMAIL P.P
APPLICANT
STATEWIDE SERVICES INC DBA STATE
36947 COOK ST STE 104
PALM DESERT
CA
92211
(442)666-8858
STATEWIDEPLUMBING
WIDE PL
2010@YAHOO.COM
CONTRACTOR
STATEWIDE SERVICES INC DBA STATE
36947 COOK ST STE 104
PALM DESERT
CA
92211
(442)666-8858
STATEWIDEPLUMBING
WIDE PL
2010@YAHOO.COM
OWNER
ROBERT DIAMOND
44565 milago
la quinta
ca
92253
(442)666-8858
FINANCIAL INFORMATION
Printed: Thursday, lune 23, 2016 9:41:28 AM 1 of 3 1
• sysrcMs
INSPECTIONS F
PARENT PROJECTS v -
Printed: Thursday, lune 23, 2016 9:41:28 AM
2•of 3
AMOUNT
>.
-
PAID
w ;DESCRIPTION
ACCOUNT
4
QTY
PAID
.PAID DATE .
RECEIPT.#
CHECK #
METHOD
BY
'BY'
a i
>
201605231
BSAS S131473 FEE
101-0000-20306
. 0
$1.00
$1.00
5/23/16
WEB815' '
709431609
CREDIT
tricia mora
ECON:
6 -
.Total
Total Paid for BUILDING STANDARDS ADMINISTRATION
$1.00 $1.00
BSA:
201605231
Credit Card Fee
101-0000-43505
0
$2.47
$2.47
5/23/16
WEB815
709431609
CREDIT
tricia mora
ECON
6
Total Paid for Credit Card Fee: $2.47 $2.47
201605231
.
PERMIT ISSUANCE
101-0000-424040
$91.85
$91.85
5/23/16
WEB815
709431609
CREDIT
tricia mora
ECON
-
6
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
201605231
WATER HEATER/VENT
101-0000-42401
0
$12.09
$12.09
5/23/16
WEB815
709431609
CREDIT
tricia mora
ECON
WATER HEATER/VENT.
201605,231
101-0000-42600
0
$7.25
$7.25
5/23/16
WEB815
709431609
CREDIT
tricia mora
ECON
PC
Total Paid for PLUMBING FEES: $19.34 $19.34
TOTALS: $114.66 $114.66
INSPECTIONS F
PARENT PROJECTS v -
Printed: Thursday, lune 23, 2016 9:41:28 AM
2•of 3
BOND •R •
ATTACHMENTS
Attachment Type CREATED OWNER DESCRIPTION
PATHNAME SUBDIR ETRAKIT ENABLED
DOC 5/23/2016 EtrakitContractor
diamond (2).pdf 1
Printed: Thursday, June 23, 2016 9:41:28 AM 3 of 3 CRMJF
SYSTrms