BPLB2017-016678-495 CALLE TAMPICO 4 VOICE (760) 777-7125
LA FAX (760) 777-7011 QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 12/12/2017
Permit Type/Subtype: PLUMBING/ Owner:
Application Number: BPLB2017-0166 Q JOSEPH VITTORI=
Property Address: 53995 AVENIDA CORTEZ D 53995 AVENIDA CORTEZ
APN: 774141023, LA QUINTA, CA 52253
Application Description: VITTORIE RESIDENCE / ATERHEATER 011
Property Zoning:
Application Valuation: $900.00 �F�4U1NoE P�jp�,ENS
Gt c�E�ppMEN .
Applicant: CG�t��t`m 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 405
PALM DESERT, CA 92211 PALM DESERT, CA 92211
(760)699-5434
Llc. No.: 936147
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, C33, C10 License No.: 9 47
g,Date� f Contractor:
ver'
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 all 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
Lender's Address:
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: BENCHMARK INSURANCE COMPANY Policy Number: CSTS009630
_ 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.
f
M'te:� j` �� ' —7 Appli ) eJ
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 FCR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to t -ie Building Official for a permit subject to
the conditions and restrictions set forth on the application.
1. Each.person upon whose behalf this appdcation 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 owrer, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless th= City of La Quinta, 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 appl cation becomes null and void if work is
not commenced within 180 days from date o�: 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 _tate 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 puQoses.
Date � Signa�(Applicart or Agent
i
y
Date: 12/12/2017
Application Number: BPLB2017-0166
Owner:
Property Address: 53995 AVENIDA CORTEZ
JOSEPH VITTORIE
APN: 774141023
53995 AVENIDA =ORTEZ
Application Description: VITTORIE RESIDENCE / HOT WATER HEATER
LA QUINTA, CA 5,2253
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 405
PALM DESERT, CA 92211
PALM DESERT, CA 92211
(760)699-5434
LIc. No.: 936147
Detail: 75. GALLON WATER HEATER CHANGE OUT [GAS] CARBON MONOXIDE ALARM(S)
TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA
BUILDING CODES.
i
r� I
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
TOTALS: $135.63
8
Prekri five Certificate of Compliance: Residential 'CF-1R-ALT-DHW
Residential Alterations Pagel of?
Project Name: Climate Zone: Permit ;#:
General Information
Site Address: Enforcement gent : Date:
Building Type: PSinglefainily D Multi Family Project Type: a lacement or Change Out of Water Heater
WATER BEATING
List newly installed water heaters and boilers for both domestic hot water heaters (DIM) and hrdronic space heating. N64Y installed
D1VH heaters and boilers uutst be gas, propatre; or use the eristin tel e.
t
Distribution Type Number [n
(Standard' Sysiem
Recirculatin )r
Tank Energy Factor or
Capacity (gal) Thermal Efficiency
, f"
•
Prekri five Certificate of Compliance: Residential 'CF-1R-ALT-DHW
Residential Alterations Pagel of?
Project Name: Climate Zone: Permit ;#:
General Information
Site Address: Enforcement gent : Date:
Building Type: PSinglefainily D Multi Family Project Type: a lacement or Change Out of Water Heater
WATER BEATING
List newly installed water heaters and boilers for both domestic hot water heaters (DIM) and hrdronic space heating. N64Y installed
D1VH heaters and boilers uutst be gas, propatre; or use the eristin tel e.
Water Heater
Type/Fuel Type'
Distribution Type Number [n
(Standard' Sysiem
Recirculatin )r
Tank Energy Factor or
Capacity (gal) Thermal Efficiency
• I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance
EYternal Tank
insulation
R -Value
• The building design features identified on this Certificate of Compliance are 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 permit application.
Company:
Date:
A(Tdress:
C oo
License:
City/ t i
Phone:
yn
1. Indicate Tipe (Storage Gas, Heat Pimp, Instantaneous, etc.)
2. Recirculating systems serving nuiltiple drvelling uurits s/un/l meet the recirculation requirements of §150(n).
requirements do not allow rite installation of a recirculating waterheatutg systenr for single dwelling tnrits.
3. 77re external water heating rank and pipes shall be insulated to meet the re uirenrents of §150(').
The Prescriptive
Contractor or Homeowner (Documentation Adthoes/Responsible Building Designer's Declaration Statement)
• 1 certify that this Certificate of Compliance documentation is accurate and complete.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design
identified -on this Certificate of Compliance.
• I certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance
conform to the requirements of little 24; Partl and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance are 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 permit application.
Company:
Date:
A(Tdress:
C oo
License:
City/ t i
Phone:
yn
all
Permit #
City of La Quinta
Building 8F Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
ect Address:
Owner's Name:
. Number:
FA.
Address: 3q
1al
Description:
City, ST, Zip:��
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Contractor:
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Telephone: l)G 1 V '`>
Address:
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Project Description:
City, ST, Zip:
gse— V -
Telephone
State Lic. # :
City Lic. 9..
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: �
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,; ,.�";?•:,.�i;�,,,:::<:;:,y
t.•..:,.,c.•:?A.!'.J...tt,�..a.<J...:ccProJect
Construction Type: Occupancy:
tYPa (circle one): New Add'n Alter Repair Demo
State Lic. #
Name of Contact Person:
^
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Sq. Ft :
n Stories:
#Units:
Telephone # of Contact Person: (P `
Estimated Value of Project: C t]
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Tide 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionsfissue
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 correctionsfisme
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees