BLCK (11-1204)50640 Mandarina
11-1204
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:' 11 -Q_0 _001 0
Property Address: 50640 MANDARINA
APN: 776 -200 -004 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1625
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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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.
Lice Class: 13 cense No.: 750957
Date: 11-3—,( ntractor:
OWNER -B DECLARATION
I hereby affirm under penalty of perjury amp, 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).:
(_ 1 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.).
(_ 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 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:
LQPERMIT
Owner:
CITRUS 18 GROUP, LLC
30875 DATE PALM ROAD
CATHEDRAL CITY, CA 92234
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/03/11
0i
Contractor: r
GHA ENTERPRISE, INC. '401V J n 9 2O»
30875 DATE PALM DRIVE, U E C ,1
CATHEDRAL CITY, CA 922 4 ir1 Q!`
(760) 969-1400 .t- LA.4411N7A I
Lic. No.: 750957
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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.
Ill 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 0000223-2010
_ 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.
ate: ,11-3 t( plicant:
WARNING: FAILURE TO SECUWORKERS' CO COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMI ENALTIES 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 that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to buildingcons suction and hereby authorize representatives
of this ,county to enter upon the above-mentioned propett o nspection purposes.
ate: 91-3-11 ignature (Applicant or Ag
Application Number
11-00001204
WALL/FENCE
PERMIT
•00
Permit
Additional desc
39.00
plan
Check Fee
1625
Permit -Fee
Valuation
Issue Date
Date .
5/01/12
Extension
Expiration
15.00
Qty Unit Charge Per
BASE
FEE
24_00 -
2.0000
HND BLDG
501-2,000------------------------
12.00
-
Special Notes and
Comments
WALL AT REAR
P L, CITY
/
65 L.F. 6' GARDEN
STANDARD..2010 CODES------------
---------------------------
-----------
__ ----------------------
--
(S131473)
1.00
---------------�---
BLDG STDS ADMIN
___
Other Fees
Credited
Due
Charged
Paid_ _
---------- -----=----
39.00
Fee summary
-------
-----39.00
------
.00
_
Permit Fee Total
00
•00
.00'
.00
00
.00
1.00.
Plan Check Total
1.00
00
00
40.00
Other Fee Total
40.00
.00
Grand Total
Bin
50 Y b 1 C) City Of. ra u1 nl.CI
50. Building 8C Safety Division..•.: . ;..
Box 1.504 78-495 Calle Tampico
La Quinta, CA 92253 -'(760) 777-7012
6° BuildingPermit Application and Tracking Sheet
Permit #P.O.
Project Address: V1 V fk 9,` 1Z CJ (A p
Owner's Name: C. * • -r u S 1% 6y -o,) p L l,. c
A. P_ Number:
Address: oe-1 5 ooT E- Pe.kM a 2
Legal Description: T 1A i✓ L T• Q v--sL Lv
City, ST, Zip: Cc.P T k C -V Ca\ C4--( Cc, q7-2
Contractor: G Vk br
P . seS i ?,JL
x
Telephone moo' °) b`1 - i LA UG ~ •#: ' '" F
Address: .3 p -1 S DO V C- \
Project Description: ISG gni Uk> - W 0.\l, S .
City, ST, Zip: Camel✓a\ Qt - F Cv 9-Z- 3 e!-
5 LoT S ,
Telephone:'
sv..z >:•
[ eJ Lia FT 2c.Gh
State Lic. # : -1 S b S
CityLic. #;
Arch., Engr., Designer: MOS C 0.n S u\ -h n
j' T P, I_ L
Address: 1 8c1cso
City, ST, Zip: LQ C, ZZS 3
Telephone: (,o .
P 7 -1 1 - 4o t 3
.'.` z`
a .
Construction Type: lo oLK Vkkk\ Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
sv...
State Lic. #:. " "' '`w'•
Name of Contact Person: .,A \.e x Goo -U, U S
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 2C? J 5 ``-`
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKNG
PERMIT FEES
Pian Sets
Plan Check submitted
Item Amount
Structural Calcs.
Reviewed, ready 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 pian
2'' Review, ready for correctionstime
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'a Review, ready for corrections/issue
Devdoper impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees