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BPLB2017-0167Applicant: STATEWIDE SERVICES INC DBA STATE WIDE PL 73-700 DINAH SHORE DR SUITE 405 PALM DESERT, CA 92211 T 4 4aw DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERLI,IT OEC 12 2017 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. C33. C10 License Nra7936147 Dater d` /2" 1 / e!F�c—ontra ITA DEPARTiAENT 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 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 N Lender's Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/12/2017 Owner: KRISTYL ADAMS 45540 COLDBROOK LN LA QUINTA, CA 92253 Contractor: STATEWIDE SERWCES INC DBA STATE WIDE PL 73-700 DINAH SF.ORE DR SUITE 405 PALM DESERT, CA 92211 (760)699-5434 Llc. No.: 936147 WORKER'S COMPENSA-ION DECLARATION I hereby affirm under penalty of perjury one cf the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 37D).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: BENCHMARK INSURANCE COMPANY Polity Number: CST5009630 I certify that In the performance of,the work for which this permit is issued, I shall not employ any person In any manner sc 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: APp i a • C WARNING: FAILURE TO SECURE WORKERS' CCMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI JAL 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 ACKNCWLEDGEMENT IMPORTANT: Application Is hereby made to tie Building Official for a permit subject to the conditions and restrictions set forth on th.s application. 1. Each person upon whose behalf this applxation is made, each person at whose request and for whose benefitwork is perforned 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 Qulnta, its officers, agents, and employees for any act or omission related to -he work being performed under or following issuance of this permit. 2. Any permit issued as a result of this appltation 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 ordliriances and state laws relating to building construction, and hereby authorize representatives of this acioter upon the above-mentioned property for inspection purposes. Dater �� Sigpature_(APPlicarc or Agen i 78-495 CALLE TAMPICO, LA QUINTA, CALIFORNIA 92253 Permit Type/Subtype: PLUMBING/ Application Number: BPLB2017-0167 Property Address:. 45540 COLDBROOK LN L APN: 604432009 Application Description: VITTORIE RESIDENCE / H Property Zoning: Application Valuation: $900.00 Applicant: STATEWIDE SERVICES INC DBA STATE WIDE PL 73-700 DINAH SHORE DR SUITE 405 PALM DESERT, CA 92211 T 4 4aw DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERLI,IT OEC 12 2017 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. C33. C10 License Nra7936147 Dater d` /2" 1 / e!F�c—ontra ITA DEPARTiAENT 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 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 N Lender's Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/12/2017 Owner: KRISTYL ADAMS 45540 COLDBROOK LN LA QUINTA, CA 92253 Contractor: STATEWIDE SERWCES INC DBA STATE WIDE PL 73-700 DINAH SF.ORE DR SUITE 405 PALM DESERT, CA 92211 (760)699-5434 Llc. No.: 936147 WORKER'S COMPENSA-ION DECLARATION I hereby affirm under penalty of perjury one cf the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 37D).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: BENCHMARK INSURANCE COMPANY Polity Number: CST5009630 I certify that In the performance of,the work for which this permit is issued, I shall not employ any person In any manner sc 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: APp i a • C WARNING: FAILURE TO SECURE WORKERS' CCMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI JAL 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 ACKNCWLEDGEMENT IMPORTANT: Application Is hereby made to tie Building Official for a permit subject to the conditions and restrictions set forth on th.s application. 1. Each person upon whose behalf this applxation is made, each person at whose request and for whose benefitwork is perforned 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 Qulnta, its officers, agents, and employees for any act or omission related to -he work being performed under or following issuance of this permit. 2. Any permit issued as a result of this appltation 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 ordliriances and state laws relating to building construction, and hereby authorize representatives of this acioter upon the above-mentioned property for inspection purposes. Dater �� Sigpature_(APPlicarc or Agen i a Date: 12/12/2017 Application Number: BPLB2017-0167 Owner: Property Address: 45540 COLDBROOK LN LN KRISTYL ADAMS APN: 604432009 45540 COLDBROOKLN Application Description: VITTORIE RESIDENCE-/ HOT WATER HEATER LA QUINTA, CA E-2253 Property Zoning: Application Valuation: $900.00 Applicant: Contractor: STATEWIDE SERVICES INC DBA STATE WIDE PL STATEWIDE SERVICES INC'DBA STATE WIDE PL 73-700 DINAH SHORE DR 73-700 DINAH SHORE DR SUITE 405 SUITE 40S PALM DESERT, CA 92211 PALM DESERT, C4 92211 (760)699-5434 Llc. No.: 936147 ------------------------------------------------------------------=-------------------------- Detail: 50 GALLON WATER HEATER CHANGE OUT [GAS] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA BUILDING CODES. a FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101=0000-42404 0 $98.83 Total Paid for PERMIT ISSUANCE: $98.83 DESCRIPTION ACCOUNT QTY AMOUNT WATER HEATER/VENT 101-0000=42401 0 $13.00 DESCRIPTION ACCOUNT QTY AMOUNT WATER HEATER/VENT PC 101-0000-42600 0. $7.80 Total Paid for PLUMBING FEES: $20.80 'DESCRIPTION ACCOUNT QTY AMOUNT RECORDS MANAGEMENT FEE 101-0000-42416 0 $10.00 Total Paid for RECORDS MANAGEMENT FEE: $10.00 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 Permit # City of La Quinta Building 8r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet :CC Owner's Name: FNbeti Address: on: City, ST, Zip: Contractor. Telephone hag Address:; 2 �'ft Project Description: City. ST, Zip: Telephone: \(n� -„�:.:�i},xN 6:":��M. :mow•. �'.;' State Lie. # : City Lie. #: Arch., Engr., Designer: Address: City., ST, Zip: Telephone:r`,,k.>;.4 State Lie. #:n ' �.o. Gfii i `F�uX;2 : c'{'ry•';` r!��•' )lf y '.�'�ece. Construction Type: Occupancy: Project type (circle one): New Add+ n Alter Repair Demo Name of Contact Person: o (x -11-0 Sq. FL: # Stories:# Units: Telephone # of Contact Person Q 7 Estimated Value of Proilm l� APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd Rec'd TRACING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Rcylewed, rcady for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°d Review, ready for correctionshissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE: '^' Review, ready for correctionsrame Developer Impact Fee Planning Approval Called Contact Person AXP,P, Pub. Wks. Appr Date of permit issue School Fees T Total Permit Fees I General Information Site Address: S CO forcement enc" : Date: Building Type.A Single Family 0 Multi Family Project T Re lacement or Change Out of Water Heater WATER HEATING List new•ir installed ivaier heaters and !oilers for btith domestic hot water heaters-(DWH) and h d onic space heating. NeK{i• installed DWH heaters and boilers must be gas. propane. or use the existing el tl . DiuribWon Type Wain Heater (Standard. Nuri*cr 1n Tank Energy Factor or TypdFvd Type' Recircubfind S em Capacity (gap nierrrial F.1Fici--y Ettt6wl Tank Insulation 1. Indicate 75pe (Storage Gas. Heat Ptaitp: Instantaneous. etc.) 2. Recirculating systems serving multiple dwelling units shall meet the recirculation requirements of §150(n). The Prescriptive. requirements do not allow the installation of a recirculating µrater heating system for single dwelling tants. 3. The a vernal water heating tank and pipes shall be insulated to meet the requirements of 6156% Contractor or Homeowner (Documentation Author's/Responsible Building Designer's Declaration Statement) • I certify that this Certificate of Compliance documentation is accurate and complete. • 1 am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on this Certificate of Conwliance. • 1 certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform to the requirements of Title 24. Pan I and 6 of the California Code of Regulations. . The building design features identified on this Certificate of Compliance ane consistent with the information provided to document this building design on the other applicable compliance forms. worksheets, calculations. plans and specifications submitted to the enforcement Agency for approval with this building it applicaiion. Na Si l�v ` Bio _ Q1 iwrlrrss: -Lt` J uLA GQ-C��l.►C1