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RPL (11-0068)50550 Mandarina 11-0068 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T &_ , foi4a" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: Architect or Engineer: I --------------------------------------------------- - 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 d Professionals Code, and my License is in full force and effect. License Class: A License No.: 859859 Date: ontracto OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjur hat I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Susi ss 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 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: C Lender's Address: LQPERMIT Owner: CITRUS 18 -GROUP, LLC 30875 DATE PALM DRIVE, STE CATHEDRAL CITY, CA 92234 Contractor: HENRY'S ENGINEERING P.O. BOX 10290 INDI.O, CA 92202 (760)393-7636 Lic. No.: 859859 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/19/11 C n Q JAN,2v- 1011 CITy 0 ,.LA QU1 M F!IVA (,1r +D;:r rl ------------------ 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 STATE FUND Policy Number 1932825 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 shoul become subject to the workers' compensation provisions of Section 3700 of the Labor , I all forthwith comply with those provisions. teO) f pplicanc WARNING: FAILURE TO SECURE W KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITI TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR C DE, 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 th6theabove' formation is correct. I agree to comply with all city and county ordinances and state laws relating toin struction, and hereby authorize representatives of this cou ty to enter upon the above-mentioned pr spec - n purposes. e:Q1 ZS () ignature (Applicant or•Agent): Application Number: - 11-00000068 Property Address: 50550 MANDARINA APN: 776-200-001- - Application description: POOL - RESIDENTIAL Property. Zoning: LOW DENSITY RESIDENTIAL Application valuation: 2200.0 T &_ , foi4a" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Applicant: Architect or Engineer: I --------------------------------------------------- - 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 d Professionals Code, and my License is in full force and effect. License Class: A License No.: 859859 Date: ontracto OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjur hat I am exempt from the Contractor's State License Law for the following reason (Sec. 7031 .5, Susi ss 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 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: C Lender's Address: LQPERMIT Owner: CITRUS 18 -GROUP, LLC 30875 DATE PALM DRIVE, STE CATHEDRAL CITY, CA 92234 Contractor: HENRY'S ENGINEERING P.O. BOX 10290 INDI.O, CA 92202 (760)393-7636 Lic. No.: 859859 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/19/11 C n Q JAN,2v- 1011 CITy 0 ,.LA QU1 M F!IVA (,1r +D;:r rl ------------------ 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 STATE FUND Policy Number 1932825 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 shoul become subject to the workers' compensation provisions of Section 3700 of the Labor , I all forthwith comply with those provisions. teO) f pplicanc WARNING: FAILURE TO SECURE W KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITI TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR C DE, 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 th6theabove' formation is correct. I agree to comply with all city and county ordinances and state laws relating toin struction, and hereby authorize representatives of this cou ty to enter upon the above-mentioned pr spec - n purposes. e:Q1 ZS () ignature (Applicant or•Agent): C ,- .Application Number . . .11-00000068 Permit BLDG POOL PERMIT INV FEE Additional desc . Permit Fee 450.00 -Plan Check Fee*. 146.25 Issue Date :. . . Valuation . . . . 22000 Expiration Date 7/18/11 Qty Unit Charge Per Extension BASE FEE 90..00 20_00 18.0000 ----------------------------------------------------------------------------- THOU BLDG 2,001-25,000 360.00 Permit . . . MECH POOL Additional desc . Permit Fee. 26..00 Plan Check Fee 6.50 Issue Date . . . . Valuation 0 . Expiration Date 7/18/11 Qty Unit Charge Per Extension BASE FEE 15.00 1.00- 11.0000 EA MECH FURNACE >100K 11.00 Permit ELEC POOL PERMIT -RES Additional desc . Permit Fee 45.00 Plan Check Fee.. 11.25 Issue Date Valuation . . . . 0 Expiration Date -.' . 7/18/11 Qty Unit Charge Per. Extension BASE FEE 15.00 1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00 Permit PLUMBING Additional desc . Permit Fee 33.00 Plan Check Fee 8.25 Issue Date Valuation 0 Expiration Date 7/18/11 Qty Unit Charge Per Extension BASE FEE 15.00 2.00. 6.0000 EA PLB FIXTURE 12.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ------------------------------------------------=----------------- Special Notes and Comments ---------- POOL/SPA. ALARMS/BARRIERS SHALL BE IN LQPERMIT Application Number . . . . . 11-00000068 Special Notes and Comments PLACE AT PRE -PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT INCLUDED. INVESTIGATION FEE ASSESSED PER 1997 UNIFORM ADMINISTRATIVE CODE §304.5 FOR WORK BEGUN WITHOUT BUILDING PERMIT. 2010 CODES. -------------------_---------------------------------------- -- Other Fees . . BLDG STDS ADMIN (SB1473) - 1.00 Fee summary Charged Paid Credited 'Due Permit Fee Total 554.00 .00 .00 554.00. Plan Check Total 172.25 .00 .00 172.25 Other Fee Total 1.00 :00• 00 1.00 Grand Total 727.25 .00 .00 727.25 LQPERMIT 50 - o HA LA PROPERTY LINE 5' BLOCK WALL Bin # City Of La Qul'ta Building 8c Safety Division Permit # P.O. Box 1504, 78-495 Calle Tampico U Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: -SD -65o API8421 Owner's Name: l ► ^ i A. P. Number. Address: . Legal Description: 50 S City, ST, Zip. Contractor: N 12 5 1•9C l i v Telephone: Address: P o 80X I O2 -I ® Project Description: City, ST, Zip: lt-4I0 CA 1220 2 bwIMMW6 oL 58A Telephone: -760-758.s$cj State Lic. # !City Lie. #; Arch., Engr., Designer. D Q. Phri-rLG'P— Address:77-725 6AFieLo 4* ( 3O City, ST, Zip: DsbW CA Telephone: '7(po.-772 .q y f I Construction Type: Ocenpancy: State Lic. #: -3-3 q y Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: CNP -1 TIAPJ LDZArjo Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: % ,2?S, cl -7 -744 Estimated Value of Project: 22 0 O APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Rcq'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cala. Reviewed, ready for corrections Plan Check Deposit Truss Coles. Called Contact Person Plan Check Balance Tide 24 Cales. Pians picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2'! Review, ready for corrections/issue Electrical Subcoutactor IAst Called Contact Person Plumbing Grant Deed Plans picked up — EtE —S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE: 3" Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person ElE A.LP.P. Pub. Wks. Appr Date of permit Issue School Fees Total Permit Fees