SFD (12-0749)51090 Mandarina
12-0749
w
P:O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA
92253
Application Number: '
C12--_000007.4=9
Property Address:
51090 MANDARINA
APN:
776-210-013- - -
Application description:
DWELLING - SINGLE FAMILY
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
290871
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
DETACHED
Owner:
CITRUS 18 GROUP,
30-875'DATE PALM
CATHEDRAL CITY,
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760).777-7153
LLC
DRIVE, 'STE". C
CA 92234 i
Contractor:
A licant' Architect or Engineer' GHA ENTERPRISE, INC. v
Date: 8/01/12
PP .p
30875 DATE PALM DRIVE, SUI
-1 CATHEDRAL CITY, CA 92234
(760) 969-1400
Lic. No.: 750957
LICENSED CONTRACTOR'S DECLARATION -
1 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:
% 3 License No.: 750957
te: 0 / / / / ontractor:
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 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).:
(_ 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 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 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
Q 3700 of the bor Code, I shall forthwith ccoom/p/Ly with those provisions. -
Oate: `-t plicant: /T -
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 ($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 Ouinta, 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 cou/rt/y[y to enter upon the above-mentioned property for ' spec on oseson pur
Date: ! / ature (Applicant or Agent):C
Application Number .
". 12-00000749
Permit . . .
ELEC-NEW RESIDENTIAL
Additional desc .
Permit Fee . ." . .
139.89
Plan Check Fee
34.97
Issue Date
Valuation
0 .
Expiration Date
1/02/13
Qty Unit Charge
Per•
Extension
BASE
FEE
15.00
3198:'00 .0350
ELEC
NEW RES-- 1 OR 2 FAMILY
111.93
648.00- .0200
ELEC
GARAGE OR NON-RESIDENTIAL
12.96
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee . .
1308.00
Plan Check Fee
850.20
Issue Date
Valuation . . . .
290871
Expiration Date
1/02/13
Qty Unit Charge.
Per
Extension
BASE.FEE
639.50
.191.00 3.5000
THOU BLDG
100,001-500,"000
•668.50
Permit
GRADING PERMIT
Additional desc .
Permit Fee
15.00
Plan Check Fee
.00
Issue Date
Valuation
0
Expiration Date
1/02/13
Qty Unit Charge.
Per
Extension
BASE
FEE
15.00
Permit. . . .
MECHANICAL
Additional desc .
Permit.Fee . . . .
118.00
Plan Check Fee'.
25.75
Issue Date . . . .
Valuation . . .
0
Expiration Date
1/02/13
- Qty Unit Charge
Per
Extension
BASE
FEE
15.00
2.00 9.0000
EA MECH
FURNACE <=100K-
18.00
.00 9.0000
EA MECH
B/C <=3HP/100K BTU
.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
LQPERMIT
LQPERMIT
Application Number
. . 12-00000749
Permit . . . PLUMBING
Additional desc .
Permit Fee . . .
211.50 Plan Check Fee
52.88
Issue Date . . . .
Valuation
0
Expiration.Date
1/02/13
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
2.00 7.5000
EA PLB WATER HEATER/VENT
15.00
.1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00
_ 1.00 9.0000
EA PLB LAWN SPRINKLER SYSTEM
9_00
10.00 .7500
EA PLB GAS PIPE >=5
7.50
1.00 15.0000
EA PLB GAS METER
15.00
-----------------------------------------------------
Special Notes and Comments
SFD - LOT 19, PLAN 2A,
3198 SF. PERMIT
DOES NOT INCLUDE POOL,
SPA, BLOCK WALLS
OR DRIVEWAY APPROACH.
2010 CODES.
Other Fees . . .
. ART IN PUBLIC.PLACES-RES
227.18
BLDG STDS ADMIN (SB1473)
12.00
DIF COMMUNITY CENTERS -RES
104.00
DIF CIVIC CENTER - RES
1089.00
ENERGY REVIEW FEE
85.02
DIF FIRE PROTECTION -RES
612.00
DIF LIBRARIES - RES
334.00
MULTI -SPECIES (MSHCP) FEE
1254.00
DIF PARK MAINT FAC - RES
51.00
DIF.PARKS/REC - RES
1773.00
STRONG MOTION (SMI) - RES
29.09
DIF STREET MAINT FAC -RES
158.00
DIF TRANSPORTATION - RES
3592.00
Fee summary. Charged Paid Credited
--------------------
Due
---------------------------
Permit Fee Total
----------
1792.39 .00 .00
1792.39
Plan Check Total
963.80 .00 .00
963.80
Other Fee Total
9320.29 .00 .00
9320.29 .
Grand Total 12076.48
.00 .00
12076.48
LQPERMIT