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SFD (12-0316)51010 Mandarina 12-0316 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: m10011l!-12r0000031'6 Owner: Property Address: A510 70'rMANDARINA CITRUS 18 GROUP, LLC APN: 776-210-010- - - 30-875 DATE PALM DRIVE STE. C Application description: DWELLING - SINGLE FAMILY DETACHED CATHEDRAL CITY, CA 92234 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 283196 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/27/12 Contractor. D Applicant: Architect or Engineer: GRA ENTERPRISE, C Q 30875 DATE PALM I 4 v 2012 CATHEDRAL CITY, 92234 l (760)969-1400 t CITY OF LA QUINTA r _ Lic. NO.: 75095 - FINANCE DEPT ------------------------------------------------------------------------------------------------- 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. _ I. have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: B Li nse No.: 750957 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. /uateC I ntractor: ` -x 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 OWNER -BUILDER 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 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 Codall forthwith comp y with 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 hundred dollars ($500).: ate. scant: / A 6,11e (_) 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 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 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 ($100,000). 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.). - 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—) 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 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 tf)is county to ent r upon the above-mentioned property for i .plec tionn ppurposes. bat/e: Ll ure (Applicant or Agent,: Le CX yI C= Application Number 12-00000316 Permit BUILDING PERMIT Additional desc' Permit Fee . . . 1283.50 Plan Check Fee 834.28 Issue Date Valuation 283196 Expiration Date 9/23/12 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 9/23/12 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 9/23/12 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 9/23/12 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 e LQPERMIT Application Number . . . . 12-00000316 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 .9/23/12 Qty Unit Charge Per "Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments SFD - LOT 16 PLAN 1CR, 3115 S.F. PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS. OR DRIVEWAY APPROACH. 2010 CODES. 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