BP 13-1433P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
13-00001433
52580 AVENIDA ALVARADO
773-284-004- - -
PATIO COVER - RESIDENTIAL
COVE RESIDENTIAL
3000
Tit(t440"
Architect or Engineer:
�\vci
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 usiness and P elanals Code, and my License is in full force and effect.
License Class. 13 A 1. J LicenseNo.: 920968
Date: CnntraCtor.
❑ NER-BUiLDER DECLARATION
1 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.).
(_ 1 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 Name:
Lender's Address:
Owner:
SALLY SMALLDON
52580 AVENIDA ALVARADO
PALM DESERT, CA 92255-3
(442)400-6860
Contractor: D
A BERUMEN CONSTRUCTION
PO BOX 1436
BANNING, CA 92220
(951)545-7352
Lic. No.: 920968
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/12/13
NOV 12 2013
CITY OF LA QUINTA
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 EXEMPT Policy Number EXEMPT
_1111-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 shquld become subject to the workers' compensation provisions of Section
3700 of the Labor e, I shal Ith comply with those provisions.
Date: Appllcartf:
WARNING: FAILURE TO SECURE OR RS' 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 Director of Building and Safety 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 th xq above information is correct. I agree to comply with all
city and county ordinances and state laws relating to U,7
cotructlan, and hereby authorize representatives
of this;��W�Signatvra
upon. the abova•mentioned proectlo purposes.
Dina: }Appllcant ar Ago
LQPERMIT
Application Number . . . . . 13-00001433
Permit . . . PATIO COVER 2013
Additional desc . .
Permit Fee . . . . 95.81 Plan Check Fee
.00
Issue Date . . . . Valuation
285
Expiration Date . . 5/11/14
Qty Unit Charge Per
Extension
1.00 95.8100 EA MISC PATIO COVER, STD
----------------------------------------------------------------------------
95.81
Permit . . . ELECTRICAL 2013
Additional desc . .
Permit Fee . . . . 23.83 Plan Check Fee
.00
Issue Date . . . . Valuation . . . .
0
Expiration Date . . 5/11/14
Qty Unit Charge Per
Extension
1.00 23.8300 LS ELEC DEVICES, FIRST 20
23.83
----------------------------------------------------------------------------
Special Notes and Comments
PATIO COVER- 285 SQ FT DURALUM SOLID
PATIO COVER AND (1) FAN. 2010 CALIFORNIA
BUILDING CODES.
-----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, PATIO COVER
94.38
PLAN CHECK, ELECTRICAL
23.83
PERMIT ISSUANCE M/P/E
90.57
STRONG MOTION (SMI) - RES
.50
Fee summary Charged Paid Credited
-----------------------------------------------------------
Due
Permit Fee Total 119.64 .00 .00
119.64
Plan Check Total .00 .00 .00
.00
Other Fee Total 210.28 .00 .00
210.28
Grand Total 329.92 .00 .00
329.92
LQPERMIT
Application Number . . . . . 13-00001433
Permit PATIO COVER 2013
Additional desc . .
Permit Fee . . . . 95.81 Plan Check Fee .00
Issue Date . . . Valuation 285
Expiration Date 5/11/14
Qty Unit Charge Per Extension
1.00 95.8100 EA MISC PATIO COVER, STD 95.81
--------------------------------------------_-------------------------------
Special Notes and Comments
PATIO COVER- 285 SQ FT DURALUM SOLID
PATIO COVER. 2010 CALIFORNIA BUILDING
CODES.
---------------..-...------------. _.-.._. -------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
PLAN CHECK, PATIO COVER 94.38
STRONG MOTION (SMI) - RES .50
Fee summary Charged Paid Credited Due
Permit Fee Total 95.81 .00 .00 95.81
Plan Check Total .00 .00 .00 .00
Other Fee Total 95.88 .00 .00 95.88
Grand Total 191.69 .00 .00 191.69
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