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BPLB2016-008478-495 CALLE TAM PICO O LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BPLB2016-0084 Property Address: 78790 BAYBERRY LN APN: 604401007 Application Description: CHANGE OUY 50 GALLON NATURAL GAS WATER HEATER 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 7000) of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: C36, A. C33, C30 License No.: 936147 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 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).: 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 offeied 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.). 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.). (_J 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 Na Lender's Add VOICE (760) 777-7125 FAX (760) 777-7011 INSPE IONS (760) 777-7153 Date: 7/6/2016. Owner: CHARLES HANN 78790 BAYBERRY LN LA QUINTA, CA 92253 Contractor: STATEWIDE SERVICES INC•DBA STATE WIDE PL 36947 COOK ST STE 104 PALM DESERT, CA 92211 (442)66678858 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: Carrier: Policy Number: _ 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 provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: 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). 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 Building Official 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 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 city to enter upon the above-mentioned property for inspection purposes. Date: Signature (Applicant or Agent): 'DESCRIPTION FINANCIAL •• 'ACCOUNT • 'QTY. AMOUNT PAID' PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 6/7/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY ALBERTO W RODRIGUEZ CREDIT WEB857 2016060715050224608 ECON } Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE Credit Card Fee 101-0000-43505 0 $2.47 $2.47 6/7/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY ALBERTO W RODRIGUEZ CREDIT WEB857 2016060715050224608 ECON Total Paid for Credit Card Fee: $2.47 $2.47 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 6/7/16 PAID BY - METHOD RECEIPT # CHECK # CLTD BY ALBERTO W RODRIGUEZ CREDIT WEB 2016060715050224ECON 608 Total Paid for PERMIT ISSUANCE: $91.85 $91.85 DESCRIPTION ACCOUNT, QTY AMOUNT PAID PAID DATE WATER HEATER/VENT 101-0000-42401 0 $12.09 $12.09 6/7/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY ALBERTO W RODRIGUEZ CREDIT WEB857 201606 670185050224 ECON DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER HEATER/VENT PC 101-0000-42600 0 $7.25 $7.25 6/7/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY ALBERTO W.RODRIGUEZ CREDIT WEB857 201606670185050224 ECON Total Paid for PLUMBING FEES: $19.34 $19.34 TOTALS: Description: CHANGE OUY 50 GALLON NATURAL GAS WATER HEATER CONDITIONS Type: PLUMBING -.WATER HEATER Subtype:. Status: ISSUED Applied: 6/7/2016 ECON CHANGEOUT (WEB) ZIP PHONE Approved: 6/7/2016 ECON Parcel No: 604401007 Site Address: 78790 BAYBERRY LN LA QUINTA,CA 92253 Subdivision: TR 23995-3 Block: Lot: 7 36947 COOK ST STE 104 Issued: 6/7/2016 ECON Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $900.00 Occupancy Type: Construction Type: Expired: 12/4/2016 ECON No. Buildings: 0 No. Stories: 0 No. Unites: 0 92211 (442)666-8858 Details: STATEWIDEPLUMBING 2010@YAHOO.COM OWNER CHARLES HANN CHRONOLOGY CONDITIONS NAME -TYPE NAME A6'DRESS'1 CONTACTS CITY STATE ZIP PHONE FAX EMAIL APPLICANT STATEWIDE SERVICES INC DBA STATE WIDE PL 36947 COOK ST STE 104 PALM DESERT CA 92211 (442)666-8858 STATEWIDEPLUMBING 2010@YAHOO.COM CONTRACTOR STATEWIDE SERVICES INC DBA STATE WIDE PL 36947 COOK ST STE 104 PALM DESERT CA 92211 (442)666-8858 STATEWIDEPLUMBING 2010@YAHOO.COM OWNER CHARLES HANN 78790 BAYBERRY LN I LA QUINTA CA 92253 (442)666-8858 FINANCIAL INFORMATION Printed: Wednesday, July 06, 2016 12:01:16 PM 1 of 3 Cff?WSYSMMS Permit Details PERMIT NUMBER City of La Quinta BPLB2016' 00884 Printed: Wednesday, July 06, 2016 12:01:16 PM 2 of 3 sysreMs CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY 201606071 ALBERTO"W BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 6/7/16 WEB857.. 505022460 CREDIT ECON RODRIGUEZ 8 Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: Credit Card Fee 101-0000-43505 0 $2.47 $2.47 6/7/16 WEB857 12016060711 505021460 CREDIT ALBERTO W ECON RODRIGUEZ 8 Total Paid for Credit Card Fee: $2.47 $2.47 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 6/7/16 WEB857 12016060711. 505022460 CREDIT ALBERTO W ECON RODRIGUEZ 8 Total Paid for PERMIT ISSUANCE: $91.85 $91.85 201606071 WATER HEATER/VENT 101-0000-42401 0 $12.09 $12.09 6/7/16 WE6857 505022460 CREDIT ALBERTO W ECON RODRIGUEZ 8 WATER HEATER/VENT 201606071 ALBERTO W 101-0000-42600 0 $7.25 $7.25 6/7/16 WEB857 505022460 CREDIT ECON PC RODRIGUEZ 8:;: Total Paid for PLUMBING FEES: $19.34 $19.34 TOTALS: $114.66 $114.66 INSPECTIONS PARENT PROJECTS REVIEWS ,,, , ,��,�����. _ �������� E� STATUS REMARKS � R ., REVIEWER REV ' IEW TYPE SENT DA������� TE DUE DATE NOTES DATE 1ST PERMIT TECH — STEPHANIE 6/7/2016 6/8/2016 6/7/2016 APPROVED ETRAKIT (1 DAY) KHATAMI Printed: Wednesday, July 06, 2016 12:01:16 PM 2 of 3 sysreMs Printed: Wednesday, July 06, 2016 12:01:16 PM 3 of 3 sysrrMs