BLCK (12-0105)51060 Mandarina
12-0105
k
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-0 00 0 010 5
Property Address: 51060 MANDARINA
APN: 776-210-012- - -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1625
Applicant:
Architect or Engineer:
l ice`"
• "
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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.
License Class: 13 License No.: 750957
ate:2 —to1 Contractor:
OWNER -BER DECLARATION
I hereby affirm under penalty of perjury t t 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 (5500).:
(_) 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, 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: I 1 ►wy
Lender's Address: 1_ r
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/06/12
Owner:
CITRUS 18 GROUP
30875 DATE PALM DRIVE jn—
CATHEDRAL CITY, CA 92234 / 7
lipiii L_3 .. 20.12 t
--
Contractor:
GHA ENTERPRISE, INC. 4 l;('fyOF
30875 DATE PALM DRIVE, SUITE C_` "='f' •
:.:._
CATHEDRAL CITY, CA 92234
(760),969-1400 .
Lic. No.: 750957
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 0000223-2011
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 Code, I shall forthwith comply with those provisions.
Ap nt:
WARNING: FAILURE TO SECURE KERS' COMP TION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL P IES AND CIVIL FINES UP TO ONE HUNDflED THOUSAND
DOLLARS IS 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 construction, and hereby authorize. representatives
of this county to enter upon the above-mentioned o or inspection purposes.
te: gnature (Applicant
LQPERMIT - -
Application Number .12-00000105
Permit WALL/FENCE PERMIT •INV FEE
Additional.desc .
Permit Fee . . . 78.00 Plan Check Fee
00
Issue Date Valuation . . .
. 1625
Expiration Date 8/04/12
Qty Unit Charge Per
Extension
BASE FEE
30.00
12.00 4.0000 HND BLDG 501-2,000
48.00
Special Notes and Comments
65 L.F. 6' BLOCK WALL AT REAR OF
PROPERTY. INVESTIGATION FEE ASSESSED PER
1997 UNIFORM ADMINISTRATIVE CODE §304.5
FOR WORK BEGUN WITHOUT BUILDING PERMIT.
2010 CODES.
Other Fees . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid - Credited
Due
Permit Fee Total 78.00 .00 .00
78.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 :00 .00
1.00
Grand Total 79.00 .00 .00
79.00
LQPERMIT - -
Bln. # :.
• .
City. of La Quints
Building 8r Safety Divfslon
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Building Permit' Application and Tracking Sheet
Pernik # G
1a
ProjectAddtess:5 0 rs18 n J`IZ®
Owner's Name: .Gl
A. P. Number._-` M {P tor-> A (Z -i co -A D q—. .
Address: 117
LegalDescription:
City, ST, Zip. c «.F Ca ck2 7 7& J
Contractor. to 41A &r -q t rk -CS t1i C-
Telephone:
Address: C) '1 b 0.<, .,t ✓
Project Description: ' Z i ►.1 'r o;r
City, ST, Zip: C-CM-Vr--2 Q - CA -1 C -2\-e\1, 2 -V-1
LG IL . 1c0. \ CLt
Telephone:., -q - ``'( >J
Lc+kS • -;r'v2
State Lic. 4:150 9 $"7 City Lir #;
Arch.; Engr., Designer
Address: '1 9:20 A4C. til
City, ST, zip: L CcL X122 S.3
Lo T Zo 226
Telephone: '7(,o '11 110.' 3
State Lic. #:
Constructione: •
TYP !a1 Occupancy: Sr- O.
Project type (oircle one): ED Add'n Alter Repair Demo
Name of Contact Person: ,s %A, LA- Z
Sq. Ft.: # Stories:
# Univ:
Telephone # of Contact Person: ' (, -Z') j —gyp ` 3
Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS UNE
p
Submittal
Req'd
Recd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item Amount
Structural Coles
Reviewed, ready for corrections
Plan Check Deposit. .
Truss C21cs•
Called Contact PersonPian
Check Balance
Title 7A Calcs.
Plans picked up
Constrnetion
Flood plain plan
Plans resubmitted
Mechanical
Giading plan
2`' Review, ready for corrections/issue
Electrical
Subeontaetor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
&hLL
ILO.A. Approval
Plans resubmitted
Grading
IN $OUSE:-
'''° Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees