BLCK (12-0455)50940 Mandarina
12-0455
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING 8c SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
7 Date: 4/25/12
Application Number: L2=00000455_ Owner: '
Property Address: 50940 MANDARINA CITRUS 18 GROUP, LLC
APN: 776-210-008-- t 30875 DATE PALM DRIVE STE C
Application description: WALL/FENCE LA QUINTA, CA 92253 rTE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 3450ContractorR 3 0 20'11Applicant: Architect or Engineer: GHA.ENTERPRISE, INC. 30875 DATE PALM,DRIVE, 'CATHEDRAL CITY, CA• 922OF LA®UINTA
(760) 969-1400 NANCEDEPT.
Lica No.: 750957
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION '
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with - _ I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Licens Class: B License No.: 750957 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date: 30 - ntractor: I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
_ _k Code, for the performance of the work for which this permit is issued. ,My workers' compensation
OWNER -BUILDER D RATION insurance carrier and policy number are:
I hereby affirm under penalty of perj that I am exempt from th ntractor's State License Law for the Carrier STATE FUND Policy Number 71922311
following reason (Sec. 71 .5, Busines nd.Esnfessien o e: 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 so as to become 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 should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthwith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by .
e any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1$500).: . ate: '30-t A ica
( ) 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 SEC E WORKERS' COMPENSA COVERAGE 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 CR ND CIVILFINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS J$100,000). 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, 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 res trictionsset 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,
) 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
- 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.
_ Date: • Owner: 2. Any permit issued as a result of this application becomes null and void if work is not commenced ,
within 180days from date of issuance of such permit, or, cessation of work for 180 days will subject
CONSTRUCTION LENDING AGENCY permit to cancellation. .
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above i formation is correct. I agree to comply with all.
work for which this permit is issued (Sec. 3097, Civ. C.1. _ city and county ordinances and state laws relating to buitdi onstruction, and hereby authorize representatives
. of this oun2ty_ to enter upon the above-mentioned pr y for inspection purposes.
Lender's Name: 'e:+-tr]_- '
ture (Applicant o
Lender's Address: t'1
LQPERMIT
Application Number . . . . . 12-00000455
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 63.00 Plan Check
Fee
.00
'Issue Date . . . . Valuation
3450
Expiration Date 10/22/12 .
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
138 L.F. 6' GARDEN WALL, 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. #
:.
Permit # , G .
0'
ProjectAddeess: Jo6"% O
City of a Quina
Bull( log 8t. Safety Dividoti . .. .
P.O. Box 1504, 78-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit Ap licationm and Tracking Sheet
sJ4gO s Owna°sName:GST 1 ,CoVQ 1a.L
A- P. Number. MDKV-, N DZ Address:
Legal Description &C(_ -Y_ V-A\\ M ST, Zip:
Contractor. G. Telephone:
Address: I& -1S C*%Tf- MO-Q--1.Project Descriptio • gO6'f0 %Z% LW: -r e1cL'.1G- .
1'
City, sT, zip o a- C t !- : CQ. °1223 cj y p 13b 1-N FT-
TTelephone-t(ob-QEA-1
Telephone-". 4;*A . 1
Slcgp 14Wj l^ -'T Bkcy- 1
Y.6
State Lia # :"75DqS77
City Lic #; 1zol (q0 LN . F'T $\00c- 1 Z
4
Arch., 6'•, Designer. MOS GonSoLT i n 5 f, ol.o) 1 p` 1r1.) -T- BI. oC V -A* -11 . 2
y l
Address:'1eACD PAYE LA -7
City., ST, Zip: L k Q %jiv%, , Ga
AZZ453
Tam%-. G y
Telephone: 1E p-7' 1-a O laj Construction Type: %%V WUk\ Oxupanay: /.
State Lia #: project type (circle one): ew Add'n Alter Repair Demo
Name of Contact Person: ¢ L -( ,$ Sq.. FL: # Stories: #Units:
Telephone # of Contact Person:
,9 Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACMG
PERMU FEES
Plan Sets
Pian Check submitted
Item Amount
Strgduial Calm
Reviewed, ready for corrections
Plan Check Deposit.Truss .
Calls,
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted _ .
Meehaeical
Grading plan
r' Review, ready for correctionsauue
Electrical
Subcontactor Idst
Called Contact Person
Plumbing
Graut Deed
Plans picked up
S.M.l.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:.
't° Review; ready for correctionsftue
Developer Impact Fee
Planning Approval.
Called Contact Person
A:I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees I
Total Permit Fees