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
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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