BLCK (12-0812)50790 Mandarina
12-0812
P.O. BOX 1504 .
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
f
Application Number:
.Property Address:
APN: ' {
Application description
Property Zoning:
Application valuation:
Applicant:
12--aO;6:OA'0:87234
5'0 7 9-0"MANDARINA
.'776-210-003-
WALL/FENCE
LOW DENSITY RESIDENTIAL
3675
Tii / aF44"
Architect or Engineer:
1I4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------7-----------------------------
' - 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 ofessionals Code, and my License is in full force and effect.
L' ense+fClass:.B Li a leNo.: 750957
Date: ontractor:
OWNER -BUILD DECLARATION ,
I hereby affirm under penalty of perjury that.) 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).:
1—) 1, 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 am exempt under Sec. , B.&P.C. for this reason -
Date:
Ownerr
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
Date: 7/20/12
Owner:
CITRUS 18 GROUP, LLC
30875 DATE PALM DRIVE
CATHEDRAL CITY, CA 92 8 -- n
Contractor: JUL 2 3
GHA ENTERPRISE, INC. ZU12
30875.DATE PALM DRIV , SU
F QWN
CATHEDRAL CITY, CA 9 234 TA I
FIN
4!4CE DE
(760)969-1400 PT
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.
KI 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 I • Policy Number 71922311
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 oft Labor Code, I s rthwith ompl w'ih those provisions.
at
7 plicant: _
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 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 abov rnft)rmation is correct. I agree to comply with all
city and county ordinances and state laws relating to buildin fConsti n, and hereby auth rize representatives
7atte
s county to enter up n the above-mentioned propert for in ect purpo3 gnature (Applicant or Agent): ` C ..e
1
Application Number 12-00000812
Permit WALL/FENCE PERMIT
-
Additional desc .
Permit Fee 63.00 Plan Check Fee
00
Issue Date Valuation
3675
Expiration Date 1/16/13.
" Qty Unit Charge Per
Extension
BASE FEE
45.00
2.00 9.0000 THOU BLDG 2,001-25,000
18.00
---- -
- Special Notes and Comments
147 L.F. 6' GARDEN WALL @ SIDE P/L, CITY
STANDARD. 2010 CODES.
-----------------------------------------------------------------------------
Other Fees . . . . . . .BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid, Credited.
Due
• Permit Fee Total 63.00 .00 .00
63.00
Plan -Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00
Grand Total 64.'00 .00 .00
64.00
LQPERMIT
Bin. #
,[ ta
/ f L Quin
-Btdk9ng 8r Safety DWon
P.O Box 1504,78-495 Calle Tampfco
ia..Quinta, C4 92253 -:(7601777-7012
Building Permit -Application and Tracking Sheet
Permit #
ProjectAddtess: 6 n 3 pLI p'7 fbQS 2 9O
Owner's Name:. Ci hLvS 1b 6 --v p , L L C—
A. P. Number. IA4
Address: &ot?S PATI -Pal M tilt .
Legal Description:
Contractor.
City, ST, Zip: CorftTa b C44 -Y CQ g2L3 4
Telephone: _l Eo - 9 69 - 1400
Address: 3687S DM -6 R=IM old
Project Description:
City, ST, Zip:aroevej'1- Cru Y Ca 9125 4
0730 - . Zb9 L ) 1=41Mt— WKII M7A4
Telephone:
Gitj/ S p1VO:Ff'1i . ''L-8 d
State Lia # :'75oQS City Lia #t
I Li -1 L.,UF+ s $1 oCx WQ It Kirl co
4 v. 5 Z • 81
Arch., Engr., Designs. MOS CavSuLTW 6
Address:
So7y0= 14-1 `810U- waII CIC1-M 6.
C_--
Construction Type: y Occupancy:
City., ST. Zip:LA tui CSA
Telephone:°
Statc Lia #:
Name of Contact Person: e f le:15-see;6}}Sq,
Project type (circle one): 6ew3) Add'¢ Alter Repair Demo
Ft ; #Stories: # Unity:
Telephone # of Contact Person cX5 Q - gi S S74
Estimated Value of Project: 1-0,000,00
APPLICANT: DO NOT WRITE BELOW THIS UNE
0
Subcalttal
Req'd
Recd
TRACE NG
PERMIT FEES
Plan Sets
Pian Check submitted.Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Calci.
Plans picked up
Construction
Mood plain plan
Plans resubmitted.,.
Mechanical
Grading plan
Z'` Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Pians picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"° Review; ready for eorrectiondissue
Developer Impact Fee
Planning Approval •
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees