BLCK (07-1852)51030 Mandarina
07-1852
P.O. BOX 1504
78-495 CALLE TAMPICO
LA' QUINTA, CALIFORNIA 92253
Application Number: t 07-00001852 .
Property Address: ` 51030 MANDARINA.
APN: 776 -210 -011 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1692 -
T4&t 4 4 4"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
----------------------------------------------------
LICENSED
-------
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 2andPfessionals Code, and my License is in full force and effect.
License Class: B License No.: 846283
Date: (6
_ -0 r
`Contracto-
OWNER -BUILDER CLARATION
I hereby affirm under penalty of perjury that I am exempt from'th 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.).
(_) 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 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: '
LQPER1111T
Owner:
MANDARINA ESTA'i'FG T,p
5305 E. SECONE
LONG BEACH,'CP
Contractor:
TP BUILDERS, I
5305 2 SECOND
LONG BEACH, CP
('562)433-1286
Lic. No.: 8462
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS -(760) 777-7153
Date: 6/26/07
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 EXEMPT Policy Number EXEMPT
_ 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 Labor Cod Is a forthwith comply with those provisions. .
Date: 4(-(27 Applicant:
WARNING:' FAILURE TO SECURE RKEF2S' COMPENSATIO/NV ERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVS.UP. TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF CO TION, 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 thiscountyto enter upon the above-mentioned property for insp n purpos
Date: (17 v6-01Signature (Applicant or Agent):
Application Number 07-00001852
Permit . . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 39.00
Plan Check
Fee
.00
- Issue Date . . .
Valuation
1692
Expiration Date 12/23/07 .
Qty Unit.Charge Per
Extension
BASE
FEE
15.00
12.00 2.0000 HND BLDG
501-2,000
24.00
-----
Special Notes and'Comments
199 ln. ft. block walls per orco
specs
rear and side with returns".
Fee summary Charged,Paid
Credited
Due
-- - - - - - - - - - - - - -- - - - - - -
Permit. Fee Total 39.00
.00
.0'0
39.00
Plan Check Total .00
.00
.00
.00.
Grand Total 39.00
.00
.00
39.00
LQPERAIIT
Bin #
City of La Quinta
Building SL 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:' r, I- 01Jp moindar'i .A Ave
A. P. Number: Model L_o+ 11
Legal Description:
Contractor:1 nn
Ta h f l l !vQ r i el -5
Owner's Name: AndarlYlUl s - -i>°5 I -
Address: 53 S ' SL'GOnd Si L
City, ST, Zip: LonU 6ea6h CA. q 2803
Telephone: `j 2--43;J293(—
--t{3; !2$(oAddress:
Address:j j p j E ' S Gt7Yl
Project Description:
City, ST, Zip: LDn(s ! bmL `` Gf4 672 803
Telephone: 5 02- y33` .8(%
DECO -&a.ndAfrd bl ocKw6d [ 5 DIT
Pir Ll eb3 f Q ?) A/J
State Lie. #: 6- 94(o20 City. Lie. #: /02132
Arch., Engr., Designer:
jqq' Rear 5 fd and. Ke4vfri W AI (5
Address:
City, ST, Zip:
Telephone:
State Lic. #: ' / p
Name of Contact Person: Phd lalr5en 951 " TJI7' / 3 8
Construction Type: 6)OCKwall Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: Ian t
# Stories: —T#
Units:
Telephone # of Contact Person: 3Dhn . &U/f7&, i60 - 8qe- 6KI
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Persona
Plan Check Balance
Energy Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading, plan
2"' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
"dReview, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
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