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BPLB2016-007278-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 4aw` COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BPLB2016-0072 Property Address: 54065 AVENIDA CARRANZA APN: 774204014 Application Description: REMOVE & REPLACE 40 GALLON N/G 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, C10 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 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.). (_ _) 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.). ( I 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. Q. Lender's Name: Lender's VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/23/2016 Owner: B MYERS 54065 avenida carranza la quinta, ca 92253 Contractor: STATEWIDE SERVICES INC DBA STATE WIDE PL 36947 COOK ST STE 104 PALM DESERT, CA 92211 v (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: 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 5/23/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY tricia mora CREDIT WEB814 2016052316584915456 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 5/23/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY tricia mora CREDIT WEB814 2016052316584915 456 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 5/23/16 PAID BY METHOD RECEIPT # CHECK # CtTD BY tricia mora CREDIT WEB814 20160523 6 584915 ECON 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 5/23/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY tricia mora CREDIT WEB814 2016052316584915 456 ECON DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER HEATER/VENT PC 101-0000-42600 0 $7.25 $7.25 5/23/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY tricia mora CREDIT WEB814 20160523 6 584915 ECON Total Paid for PLUMBING FEES: $19.34 $19.34 TOTALS: Description: REMOVE & REPLACE 40 GALLON N/G 1111 Type: PLUMBING - WATER HEATER Subtype: Status: FINALED Applied: 5/23/2016 ECON CHANGEOUT (WEB) Approved: 5/23/2016 ECON Parcel No: 774204014 Site Address: 54065 AVENIDA CARRANZA LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 286 Lot: 4 Issued: 5/23/2016 ECON UNIT 26 ZIP PHONE Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: 6/2/2016 dcl Valuation: $900.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 STATEWIDEPLUMBING 2010@YAHOO.COM Details: 36947 COOK ST STE 104 I PALM DESERT CA I I 10-- �0 0 Applied -to Approved - Approved to Issued Issued to Finaled CHRONOLOGY 1111 CONTACTSpliql1lom ............. NAME TYPE NAME ADDRESS1 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 I PALM DESERT CA I I 92211 I. (442)666-8858 STATEWIDEPLUMBING 2010@YAHOO.COM OWNER B MYERS 54065 avenida carranza la quints ca 92253 (442)666-8858 FINANCIAL INFORMATION Printed: Thursday, June 23, 2016 9:37:57 AM 1 of 3 r sysrr:Ms DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD JOB CARD . BY . 201605231 BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 5/23/16 WEB814 658491545 CREDIT tricia mora ECON 6 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 WEB814 658491545 CREDIT tricia mora ECON 6 Total Paid for Credit Card Fee: $2.47 $2.47 201605231 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 5/23/16 WEB814-- 658491545 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 WEB814 658491545 CREDIT tricia mora ECON 6 WATER HEATER/VENT 201605231 101-0000-42600 0 $7.25 $7.25 5/23/16 WEB814 658491.545 CREDIT tricia mora ECON PC 6 Total Paid for PLUMBING FEES: $19.34 $19.34 TOTALS: $114.66 $114.66 INSPECTIONS SEQIU. INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED RESULT REMARKS NOTES DATE DATE Mtbejuna@gmail.com, SEND OWNER FINAL PLUMBING FINAL" DCL 6/2/2016 6/2/2016 APPROVED JOB CARD Printed: Thursday, lune 23, 2016 9:37:57 AM 2 of 3 sysieMs Permit Details PERMIT NUMBER �City of la Quinta BPLB2016=8072 - -' REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES DATE 1ST PERMIT TECH — MARY 5/23/2016 5/24/2016 5/23/2016 APPROVED ETRAKIT (1 DAY) FASANO BOND INFORMATION Printed: Thursday, June 23, 2016 9:37:57 AM 3 of 3 , SYST@H1S