SFD (12-0349)50940 Mandarina
12-0349
P.O. BOX 1504f 4
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
- Date: 4/13/12
Application Number: ' X12-00000349 Owner:
PFINANCEDEPgT.
Property Address: 50940 MANDARINA CITRUS 18 GROUP, LLCAPN: 776-210-008- - 30-875 DATE PALM DRIVE STApplication description: DWELLING - SINGLE FAMILY DETACHED CATHEDRAL CITY, CA 92234 Property Zoning: LOW DENSITY RESIDENTIAL 1 2Application valuation: 283196
F LA QUContractor:
Applicant: Architect or Engineer: GHA ENTERPRISE, INC.
30875 DATE PALM DRIVE, SUITE C
CATHEDRAL CITY, CA 92234
(760)969-1400
Lic. No.: 750957
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.
Li se Class: B License No:: 750957
Dater ntractor."
OWNER -BUILDER 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 )iasis 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 anownerof 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.).
( 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 (Sec. 3097, Civ. C.)•
Lender's Name:
Lender's Address:
LQPERMIT
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.
. 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 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 of the. abor Codej shall forthwith comply ith those provisions.
Oate:u bRh2 plicant: A ./111/YL
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 (5100,000). 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 construction, and hereby authorize representatives
of is county to enter upon a above-mentioned property for inspection purposes.
Date: y / /- S' ature (Applicant or Agent): 7" A r
LQPERMIT
Application Number .
. . . . 12-00000349
Permit . .
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
1283.50 Plan Check Fee
834.28
Issue Date . . . .
Valuation . . . .
283196
Expiration Date
10/10/12
Qty Unit Charge
Per.
Extension
BASE FEE
639.50
184.00 3.5000
----------------------------------------------------------------------------
THOU BLDG 100,001-500,000
644.00
Permit . .
MECHANICAL
Additional desc .
Permit Fee . . .
118.00 Plan Check Fee
29.50
Issue Date . . . .
Valuation . . . .
0
Expiration Date
10/10/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
2.00 9.0000
EA MECH FURNACE <=100K
18.00
2.00 16.5000
EA MECH B/C >3-15HP/>100K-500KBTU
33.00
7.00 6.5000
EA MECH VENT FAN
45.50
1.00 6.5000
EA MECH EXHAUST HOOD
6.50
Permit
ELEC-NEW RESIDENTIAL
Additional desc
Permit Fee . . .
136.97 Plan Check Fee
34.24
Issue Date . .
Valuation . . . .
0
Expiration Date
10/10/12.
Qty Unit Charge
Per
Extension
BASE FEE
15.00
3115.00 .0350
ELEC NEW RES - 1 OR 2 FAMILY
109:03
647.00 .0200
ELEC GARAGE OR NON-RESIDENTIAL
12.94
Permit
PLUMBING
Additional desc .
Permit Fee . . . .
200.25 Plan Check Fee
50.06
Issue Date . . . .
Valuation . . .
0
Expiration Date
10/10/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
22.00 6.0000
EA PLB FIXTURE
132.00
1.00 15.0000
EA PLB BUILDING SEWER
15.00
LQPERMIT
Application Number
12700000349
Permit . . . . . .
PLUMBING
Qty Unit Charge
Per
Extension
1.00 7.5000
EA PLB WATER HEATER/VENT
7.50
1.00 3..0000
EA PLB WATER INST/ALT/REP
3.00
1.00 .9.0000
EA PLB LAWN SPRINKLER SYSTEM
9.00
1.00 3.0000
EA PLB GAS PIPE 1-4 OUTLETS
3.00
1.00 .7500
EA PLB GAS PIPE >=5
.75
1.00 15.0000
EA PLB GAS METER
15.00
Permit . . .
GRADING PERMIT
Additional desc .
Permit Fee . . . .
15.00 Plan Check Fee
.00
Issue Date
Valuation
0
Expiration Date
10/10/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
-----------------------------------------------------------------------
Special Notes and Comments
-----
SFE - LOT 14 PLAN S.F.-PERMIT
DOES NOT INCLUDE POOLOOL,,
SPA, BLOCK WALLS
OR DRIVEWAY APPROACH.
2010 CODES.
`
THIS APPLICATION REPLACES #11-018 WHICH
_
WAS NEVER ISSUED.
--------------------------------------
Other Fees .
. . . . ART IN PUBLIC PLACES -RES
---- -----
207.99
BLDG STDS ADMIN (SB1473)
12.00
DIF COMMUNITY CENTERS -RES
74.00
DIF CIVIC CENTER - RES
995.00
ENERGY REVIEW FEE
83.43
DIF FIRE PROTECTION -RES
140.00
GRADING PLAN CHECK FEE
.00
DIF LIBRARIES - RES
355.00
MULTI -SPECIES (MSHCP) FEE
1254.00
DIF PARK MAINT FAC - RES
22.00
DIF PARKS/REC - RES
892.00
STRONG MOTION (SMI)-- RES
28.32
DIF STREET MAINT FAC -RES
67.00
DIF TRANSPORTATION - RES
1930.00
Fee summary Charged Paid Credited
'Due
Permit Fee Total
1753.72 ..00 .00
1753.72
Plan Check Total
948.08 .00 .00
948.08
Other Fee Total
6060.74 .00 .00
6060.74
Grand Total
8762.54 .00 .00
8762.54
LQPERMIT
tot lb
tot 14
CITY OF LA QUINTA - PUBLIC WORKS DEPARTMENT GREEN SHEET
PUBLIC WORKS CLEARANCE FOR RELEASE OF BUILDING PERMIT
Form updated & effective 9/25/2009
Green Sheet approvals are forwarded to the Building & Safety Department directly by Public Works. Please DO NOT
submit the Green Sheet (Public Works Clearance) Packet to the Public Works Department until ALL requirements listed
below are complete. Incomplete.applications or applications which cannot be processed will be returned to applicant.
3o 875 aatePalm3 _ sftc
Date: / / Developer: C;-I-rU c ! R G rou 0, LL C Cc►fAend rQ I C: k. , cR 92 7-13 y
Tract No. aY890- / I l,e Geode 7Ae C1,y, 16
/y
tot Tract Name: Lot No.'
50 -9Ko MQrk-wrini
The following are the requirements
Building & Safety Department:
Phone Number: ( 760 ) .96 9- /'fo d
a building permit from the
Attach Pad Elevation Certificates in compliance with the approved design elevation for building pad.(makimum
allowable deviation of +/- 0.1 foot). Pad Elevation Certificates must be current (within.6 months of current date).
If a precise grading plan creates the pad for approval, please withhold green sheet submittal until a Pad Elevation
Certificate can be provided.
Attach geotechnical certification of grading plan compliance including compaction 'reports from a licensed Soils
Engineer. Recently rough graded.. residential developments which have •a previously approved geotechnical
certification are exempt from this requirement.
Attach recorded final map or title information/grant deed showing proposed building locations are legal lots.
Complete the attached <1 acre per lot or infill project Fugitive Dust Control project information form, PM10 plan &
agreement or. provide alternative & valid City approved PM10 plan set reference number or hard copy plan.
PM10 plans for commercial & residential developments (beyond 1 lot) are submitted separately with grading plans
& are subject to additional requirements. A current PM10 certification number is required.
Attach a copy of the rough or recise grading plan to the Public Works Department showing building location(s)
for pad elevation verification. AO flood zone developments will require an approved flood plain development plan.
Attach supporting documentation for wall plan, monument sign, grease trap or special facility installations.
7. Complete avid sign the attached water quality management plan (WQMP) exemption form, if applicable. PW
approved building construction projects require either a WQMP or a completed WQMP exemption form.
Approved maps/plans may be viewed at the following link: hftp://www.la-gui6ta.org/PlanCheck/m search aspx
have reviewed and confirmed the requirements listed above as presented and find the improvements to be sufficiently
complete for construction of the proposed buildings/structures/walls/signs on the subject lot(s). Pursuant to my findings,
the. above project maybe released for building permit issuance.
This section completed by City
Recommended by:
Public Works Distribution
Date: W/ (9/
Green Sheet to Building & Safety
Green Sheet to Planning Department
Declined for approval -for reason(s) as follow(s), please correct and resubmit:
TAchedmsts. Farms & AppicaUons\.Forms & APpicabonslGREEN SHEET cover & PM10 less than 1 Acre Revised 9-25.09.doc
We'44.
City of La Quinta - PM10 Fugitive Dust Control Project Information
Construction Phase PM10 Agreement <1 acrellot or Infill Project
Project Information
Project Contractor:
Project Phase
(check one)
Construction
Demolition
Project Name: 1 k e_ 19(o LJ e. at 7 k e e;; t r
Lo
Project Tract/Lot Numbers: a1 $ 10 -1 f 16
Project Street Address: 10 10 M o, tnAac, nA
Total Acres in Active
Construction (<1 acre per
Lot):
Anticipated Start Date: / / Anticipated Completion Date:
PM10 Contact
Information
Please note: Dust control is required 24 hours a day, 7 days a week, regardless of
construction status. Person listed below is responsible for dust control during business and
non -business hours.
Name:
A i eX Go n j-.a1 -
Title:
V Pre e nt
Com an Name:
G N 19 Ent er C
Mailin Address:
30 R 7 Cj J)aa e_ PIM OfiUe. c4ife-
City, State, ZIP Code:
tat I G G A `FAA 3 `d
Primary Phone M
760 96 9-1 y4O
Fax #:
76o - 3aa - 633
24 Hour Emergency
Phone#:
76o a 5o -SSS 4
Cell Phone M
171
Email Address:
Alex co
PM10 Certificate M
C V 11 _6
❖ Shall act as his/her acknowledgement of dust control requirements and their enforceability, pursuant to SCAQMD
Rules 403, 403.1, 401, 402, 201, 203 and PERP;
❖ Shall constitute an Agreement to comply with all project conditions as identified in the approved dust control plan.
Acknowledges that dust control is required twenty-four (24) hours a day, seven (7) days a week, throughout the
period.of project performance, regardless of project size or status;
❖ Shall .ensure that each and every contractor, subcontractor and all other persons associated with the project shall
be in continuous compliance with all requirements of the approved dust control plan;
❖ Shall take all necessary precautions to minimize dust, even if additional measures beyond those listed in the dust
control plan are necessary;
❖ Shall authorize representatives of City/County to enter the property for inspection and/or abatement purposes;
❖ Shall hold harmless the City/County and its representatives from liability for any actions related to this dust control
plan Qr any City/Cou* initiated abatement activities.
TACheddists `
or Authorized Representative
SHEET cover & PM101ess than 1 Aae Revised 9-2509.doc
Date
st Control Project Information
it (<1 acre/lot or Infill Project)
TI, 2 C; rr_i S
1 $170-1 sof 16
/—Anticipated Completion Date:
quired 24 hours a day,. 7 days a week, regardless of
I below is responsible for dust control during business and
C
A . 'FAA 3 11
3
r
❖ Shall act as his/her acknowledgement of dust control requirements and their enforceability, pursuant to SCAQMD
Rules 403, 403.1, 401, 402, 201, 203 and PERP;
❖ Shall constitute. an Agreement to comply with all project conditions as identified in the approved dust control plan.
❖ Acknowledges that dust control is required twenty-four (24) hours a day, seven (7) days a week, throughout the
period. of- project performance, regardless of project size or status;
❖ Shall .ensure that each and every contractor, subcontractor and all other persons associated with the project shall
be in continuous compliance with all requirements of the approved dust control plan; .
4- Shall take all necessaryprecautions to minimize dust, even if additional measures beyond those listed in the dust
control plan are necessary;
❖ Shall authorize representatives of City/County to enter the property for. inspection and/or abatement purposes;
❖ Shall hold harmless the City/County and its representatives from liability for any actions related to this dust control
plan Qr any City/County initiated abatement activities.
or Authorized Representative
SHEET cover & PM 10 less Ow 1 Acre Revised 9-25-09.doc
Wy
Date
City of La Quinta - PM10 Fugitive Dust Control Plan (<1 acre per Lot or Infill -Project)
This Fugitive Dust Control Plan shall take into account applicable SCAQMD Regulations Rule 403, 403.1, 401, 402, 201,
203 and Portable Equipment Registration Program (PERP).
❖ WATERING: Continuous watering is required to prevent dust and must occur a minimum of four (4) times daily.
Water shall be applied from an adequate sized. metered watersource to dry soils"to prevent:
■ Visible dust emissions >20% opacity
■ Visible dust emissions that travel >100 feet from the source (within site)
• Visible dust emissions that cross any property line
EDUCATION: The responsible dust control Individual and key personnel shall attend SCAQMD PM10 class and
obtain PM10 certificate number prior to construction activity (training information may be obtained by contacting
SCAQMD at (909) 396-2183).
❖ CONSTRUCTION &.DEMOLITION ACTIVITIES: A copy of this approved Fugitive Dust Plan must be kept
on site. At least one short-term stabilization method must be used during off hours. At least one long-term
stabilization measure must be.used within ten (10j days of ceasing activity.
❖ WEATHER MONITORING: Wind predictions shall be monitored.
❖ SIGNAGE: Approved'signs shall be installed at a' highly visible location. Please refer to the Coachella Valley
Fugitive Dust Control Plan Handbook for Construction Signage Guidelines.. .
❖ TRAFFIC: Construction traffic shall not .be allowed on the pad, unless absolutely. necessary. If vehicles operate
on pad, pad shall be kept firm and moist through hose watering and sprinklers; and a maximum traffic speed of
15mph will be enforced. Fugitive Dust shall be prevented by fencing off site to prevent unauthorized traffic on
pad.
❖ PARKING: Parking is not allowed on pad. All vehicles must park on street at designated areas only.
❖ TRACK OUT: Provide 24 hour street cleaning and track out system as approved by City Public Works
inspectors. No dirt on public.or private roads. Track out shall be cleaned up within one (1) hour of incident and at .
the conclusion of each .workday.
❖ DIRT PILES: Dirt. piles shall be limited to -50 '
o 50,cubic. yards and built per California Building Code grading
requirements. Piles shall be kept moist or covered with tarp material. Larger dirt piles will require stockpile or
grading permit.
❖ FENCING: Provide PM10 fencing at perimeter of public roads and where applicable. Wood slat fencing can be
installed at rear of property and return 20 feet on either side if HOA restrictions apply. Block walls can'replace
PM10 fencing during the construction phase.
❖ EQUIPMENT: Extra hoses and sprinklers shall be maintained on site.
❖ EXCAVATION MEASURES: All areas to be excavated or graded shall be. pre -watered.. Water shall also be
applied during excavation or grading operations.
❖ DUMP TRUCKS: Open top dump trucks shall be wet down, moist and covered with a tarp prior to leaving site.
❖ INACTIVE SITE: Within 10 days of ceasing of activities, re -vegetate or permanently stabilize as required.
RECORD KEEPING: Fugitive Dust Control Plan records (i.e. self inspection records,. records of use of chemical
suppressants, etc.) shall be maintained for 3 years. by the Property. Owner .(or Authorized Representative).
Property Owner shall. notify the City and SCAQMD within 10 days of completion of project:
T:1Cheddists - Forms.& ApplicationsTonns & Applicetions%GREEN SHEET cover & PM10 less than 1 Acre Revised 325.09.doc