BLCK (12-1158)50820 Mandarina
12-1158
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: =-1-2-00001-1-58
Property Address:
50820 MANDARINA
APN:
776 -210 -004 -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
3250
T4&t 4 4 Q"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
CITRUS 29 GROUP, LLC
30875 DATE PALM DRIVE
CATHEDRAL CITY, CA 9223A_
D
Contractor:
GHA ENTERPRISE, INC.
30875 DATE PALM DRIVE, SU.
CATHEDRAL CITY, CA 92234
(760)969-1400
Lic. No.: 750957
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/02/12
w u
Cif2 2012
CITY OF LA QUINTA
" LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury that I censed under provisions of Chapter 9 (commencing with
I n li
I hereby affirm under penalty of perjury one of the following declarations:
Section 7 00) of Division 3 of the Busines and Pro ssionals Codp( and my License is in full force and effect.
_ I haverand will maintain a certificate of consent to self -insure for workers' compensation, as provided
Licen 'Class: B Li n e No.: 750957
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
%/ j
ate!y tractor: /
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
1-11
Code, for the performance of the work for which this permit is issued. 'My workers' compensation
OWNER -BUILD DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier STATE FUND Policy Number 71922311
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I shobject to the wor ers' compensation provisions of SectionLicense
Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
Wtobea
3700 of the Labor Cowith p ith those provisions.
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 hundreddollars IS5001.:
ate. A cant:
(_ I 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION C VERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
APPLICANT ACKNOWLEDGEMENT
1 _ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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: r 't
LQPERMIT
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 isnot 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 inf atio is correct. I 9gree to comply with all
city and county'ordinances and state laws relating to building c truction and ereb a horize representatives
of this county to enter upon the above-mentioned property inspectio p s
DAY 51
" Q `/4?sig Lre (Applicant or Agent):
Application Number . . . . . 12-00001158
Permit WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . . 63.00
Plan Check Fee
.00
Issue Date . . . .
Valuation
3250
Expiration Date 3/31/13
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
- 130 L.F. 6' GARDEN WALL @ SIDE
P/L,
CITY STANDARD.
-----------------------------------------------------------------
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
J
LQPERMIT
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alomFoultv Wow wow C=o= ft rot ONAWA on EUSUS �L%//
IN THE CITY OF LA GUINTA. STATE OF CAUFOPW
AV IN" C*kVrR=VN CONTSL-41 AGREES TINT IN ACCORCAIIME �" GENCRAMY TRACT NO. 24890-1 SHT.3_M "'o" 11 Oft INDICATED W" ACCIDPTED CO*STRLACT PRACTIOM CONSTRUCTION CONTRACTOR � K C.YJ 4
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City. of La Quints
Building & Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application• and Tracking Sheet
Permit # ,
Project Address: SO$20 5®$50 So BSO
Owner's Name:. C_ii-YZ,, .t 2EP7
A. P. Number. h^ Lo °-
Address:?# Legal
Description:
City, ST, Zip: C 0. gZZSLI
Contractor. .%-hch. tC,Telephone:
16d - 46ti -McsAddress:
Project Description:
3p , j LX f ' d e
City, ST, Zip: Cps . C.l*CG223`
401' t0 50820 - f P'yp Li JTelephone:i(7p- j6
FJ -1 ypp
Lia # : -750 ctS% City Lic- #;
fro T 11 SO 1:350 — Y 30 rJ F 'State
(a 50e$0 - '3d lr i (N
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic- #: w, •, <-
Name of Contact Person: Ptu.,,A %r -r e,,lsLS
Construction Type:. N,.) Occupancy:
Project type (circle one):e& Add'n Alter Repair Demo
Sq. Ft-: # Stories: # Unit;:
Telephone # of Contact Person: "7(00 -:)LSO -e4bg , _\
Estimated Value of Project k t-{ , Oct)UO
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Wd
Recd
TRACKIIVG
PERMIT FEES-
EESPlan
PlanSets
Plan Check submitted
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cales.
Called Contact Person
Plan Check Balance
Tide 24 Calc&
Plans picked up
Construetlon
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan
2'! Review, ready for correctionarissae
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
N HOUSE:-
''" Review; ready for correcdo'nsAssae
Developer Impact Fee
Planning Approval
Called Contact Person
A.%P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees