12-1314 (AR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
12-00001314
52620 AVENIDA ALVARADO
773-284-006-18-000000-
ADDITION - RESIDENTIAL
COVE RESIDENTIAL
2500
c&t!t 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
O
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 Professionals Code, and my License is in full force and effect.
License Class: License No.:
Date: Contractor:
OWNER -BUILDER DECLARATION
I hereby afli" under penalty of porjury that I am exempt from the Contractor's Stata Ucense Law for the
following FOasorr (Sec. 7031.5, Buainaas and Pralessluns Coda: Any city or County that Faqulres a pelmlt to
construct, altar. Improve, demolish, or rapalr any structure, prior to its issuance, also requires the applicant for the
permit to file a slgned statement that he er she is lics[tsad pursuant to the provlslens of tine Contractor's State
License Law (Chapter 9 (commencing wish Section 70001 of ➢ivlsion 3.of the Business and Professions Code1 or
that he or silo is exempt tlterefrorn and the basis for the alleged exemption. Any violation of Section 7031.5 by
applicant for a permit subjects the applicant to a civil penalty of not mars then five hundred dollars (9500).:
( 1 1. as owner of the property, or my amployses wlth wegss as their sole coinpenaatlw4 wll) do the work, and
she structure Is not intended or offered for sale Mac. 7044. Business and Professions Code, Tin
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.).
(_ 1 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 a exem� under Sec. B.&P.C. Ipr�hie�asan
� � r
r Date:
wner:
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: _
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
SCHWARTZ-BERGMAN FAMILY TRUST
1521 N. SIERRA BONITA AVE
LOS ANGELES, CA 90046 „
Date: 11/30/12
Contractor: 44? U
Owner f�
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 became subject to the workers' compensation laws of California,
and agree thatXdl
ubject to the workers' compensation provisions of Section
�T t110 Lhwltit comply with those provisions.
Date: / ApplicanWARNING: FAILURE TO SECPENSATION 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 whoao roqueat and for
wlmaa bonollt work is performed under or pursuant to any permit issued as a result at this application,
the Owner, and the applicant, each agratis to, and shall defend, indemnity and hold harmless the City
of La Oulnta, its elficers, agents and employees for any act or omiselon rali ted 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 arid'stale laws relatrng to building 4,w,,,,otlon, and hereby authorize representatives
of this co ty enter n the obove-meotionod prop t I i+ purposes.
It 5igrtaturn {Applicant a Agent}-
Application Number . . . . . 12-00001314
------ Structure Information STORAGE SHED -----
Other struct info . . . CODE EDITION 2010
# BEDROOMS .00
FLOOD ZONE NO
Permit
Additional desc .
Permit Fee
Issue Date
Expiration Date .
BUILDING PERMIT
54.00
5/29/13
Plan Check Fee 35.10
Valuation 2500
Qty Unit
Charge Per
Extension
BASE FEE
45.00
1.00
9.0000 THOU
BLDG 2,001-25,000
9.00
Special Notes
and Comments
12.2FT X 16FT
X 8FT HGT (194SF) WOOD
FRAMED STORAGE
SHED IN REAR
YARD. 2010
CODES.
Other Fees
. .
. BLDG STDS ADMIN-(SB1473)rY
1.00
STRONG MOTION (SMI) - RES
.50
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
Charged Paid
54.00 .00
35.10 .00
1.50 .00
90.60 .00
Credited Due
.00 54.00
.00 35.10
.00 1.50
.00 90.60
LQPERMIT