BLCK (12-1159)50850 Mandarina
12-1159
P.O. BOX 1504
78-495 CALLE TAMPICO
'LA QUINTA, CALIFORNIA 92253
Application Number: 12-00001159
Property Address: 50850 _MANDARINA __
APN: 776 -210 -005 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 3250
c&t!t 4 e(P Q"
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 a ofessionals Co e, and my License is in full force and effect'.
License Class: rB 7 L' a No.: 750957
ataG b ! G -tractor,
OWNER-BUILDE DECLARATION
I hereby affirm under penalty of perjury that I 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).:
(_) 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 contractorls) 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 ISec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
WORKER'S COMPENSATION DECLARATION
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.
1 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 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 come subject to the workers' compensation laws of California,
and agree that, if I shout eco subject to h 'orkers' compensation provisions of Section
3700 of the Labor C , I'sha forth/th c bly with those provisions.
110 _2 /, Applicant: - . Grp
zelll
WARNING: F SECURE WORKERS' COMPENSATI 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 above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building _ t ction, and here thorize representatives
of this county to enter upon the above-mentioned property r ins _tion p es.
16ate O-2 ature (Applicant or Agent):
Date: 1.0/02/12
Owner:
CITRUS 29 GROUP
30875 DATE PALM
DRIVE
CATHEDRAL CITY,
CA 92234
D
Q
Contractor:
r "?
GRA ENTERPRISE,
INC.
30875 DATE PALM
DRIVE,SUITE
CATHEDRAL CITY
CA 92234
CITYOFLAQUI IYA
(760) 969-1400
'lRiR1CFOE'T
Lic. No.: 750957
WORKER'S COMPENSATION DECLARATION
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.
1 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 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 come subject to the workers' compensation laws of California,
and agree that, if I shout eco subject to h 'orkers' compensation provisions of Section
3700 of the Labor C , I'sha forth/th c bly with those provisions.
110 _2 /, Applicant: - . Grp
zelll
WARNING: F SECURE WORKERS' COMPENSATI 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 above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building _ t ction, and here thorize representatives
of this county to enter upon the above-mentioned property r ins _tion p es.
16ate O-2 ature (Applicant or Agent):
Application Number . . . . . 12-00001159
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
0
LQPERMIT
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BULLDINC AND SAFETY DIRECTOR DEVELDPEaIEYrt DNECIOI
CITY OF U OUNTA OF U Oli(fA
E11I,t1W PAD y
TR 24M-1 _.
AN PAD fJfY.
iR 327'51
SECTION A- A
NOT TO SCALE
AID RECOMMENDED
OVAL BY:
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Bin #
City. of La Quinta
Building 8r Safety Division
P.O. Box 1504, *78-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit Application' and Tracking Sheet
Pemtit #
Project Address: 604820 st 5850 So 9,b0
Ownees Name:. CA r -r • 2 48 C:: a P'
A. P. Number.
Addrem: -lS pptT P c1uQ_
Legal Description:
City, ST, Zip: .1 1 .V Q.+TkI. Gi k C. ct- CMZ 3`4
Contractor. GVCVO- C—
Telephone: —7(xa - q(.y
Address: 'ape), S DU'r VI-411 d -R_
Project Description:
City, ST, Zip: Cp, "g, Lc7T' t0 SO1320 - P-9mox 150, L4 i CIT".Telephone:- 6o-C16c(' (` jooState Lic. #: - 750 qS-7
Arch., EW., Designer- u -&as C.
Address:
City, ST, Zip:
Telephone:
State Lic #:
Construction Type: . NK.w Oaxrpancy:
Project type (circle one): jg Add'n Alter Repair Demo
Sq. FL: # Stories: # Units
Name of Contact Person: pxu..-[ tx n z,w,llLS
Telephone # of Contact Person: '1%tp -a 50=gg y-
Estimated Vatic of Project: k L{ OCO UO
APPLICANT: DO NOT WiBTE BELOW THIS UNE
if
Submltbl
Req'd
Recd
TRACKNG PERMIT FEES
Plies Sets
Pian Check submitted
Item Amount
Structural Caks.
Reviewed, ready for ow
Plan Check Deposit. .
Truss Cala.
Calf Contact Person
Plan Cheek Balance
Title 24 Cale.
Plans picked up
Construction
Flood PWU pin
Pins resubmitted" •
Mecharikal
Giadtng plan
Z'! Review, ready for correcBonsftow
Mewical
Sabeontactor List
Called Contact Person
plumbing
Grant Deed
Plans P6cked •p
S.M.E.
H.O.A. Approval
Plass resubmitted
Gradlas
IN HOUSEa
Review, ready tot correctionsftue
Developer Impact Fee
PLanninB Approval.
CYtIed Coauct Person
AXP.P'. "
Pub. Wks. Appr "
Date of permit hsae
School Fees
Total Permit Fees