BLCK (12-0107)51120 Mandarina
12-0107
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning: '-
Application valuation:
Applicant:
12-00000107
5112-0—MANDARINA
776-210-014- -
WALL/FENCE
LOW DENSITY RESIDENTIAL
. 5650
T4ht nF 4Qu&&
Architect or Engineer:
pIA
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: B License No.: 750957
ate: 2' 6' I a- tractor:
R -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 ($500).:
(_) 1, 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 ISec.
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. , BAP.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
1 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
Owner:
CITRUS 18 GROUP, LLC
60875 DATE PALM DRIVE
CATHEDRAL CITY, CA -92234
Contractor:
GHA ENTERPRISE, INC.
30875 DATE PALM DRIVE, S
CATHEDRAL CITY, CA 92234
(760)969-1400
Lic. No.: 750957
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/06/12
Fir 1 10",`63 2 10 122
WORKER'S COMPENSATION DECLARATION ,
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
4(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.
af3 te: '1' (a— pplicant:
WARNING: FA LURE TO SECURE W KERS' C NSATIO E-GEol AWFUL, AND.SHALL
ECTANEMPLOYERTOCRIMINAL P NALTIES AND CIVHUNDRED 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 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
oVhis county to enter up the above-mentioned property for inspection purposes.
Date:'.l Signature (Applicant or Agent):
L___1 -
Application Number . . . . . 12-00000107
Permit . . . WALL/FENCE PERMIT INV FEE
Additional desc .
.Permit Fee . . 162.00 Plan Check Fee
.00
Issue Date . . . . Valuation
5650
Expiration Date 8/04/12
Qty Unit Charge Per
Extension
BASE FEE
90.00
4.00 18.0000 THOU BLDG 2,0.01-25,000
72.00
-----
Special Notes and Comments
.226 L.F. 6' BLOCK WALL AT REAR OF
PROPERTY AND AROUND CORNER.CITY STANDARD
INVESTIGATION FEE ASSESSED PER 1997
UNIFORM ADMINISTRATIVE CODE.§304.5 FOR
WORK BEGUN WITHOUT BUILDING PERMIT.
2010 CODES.
----------------------------------------------------------------------------
------ - -
Other Fees . . . . . BLDG STDS'ADMIN (SB1473)
Other
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 162.00 .00 .00
162.00
Plan Check Total .00 .00 .00
.00
Other Fee Total 1.00 .00 .00
1.00*
Grand Total 163.00 .00 .00
163.00
LQPERMIT
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Cur of La Qdin: ia
Buffft a Sare[y Dfvlsfon '
P.O. Box 1504,-78-49S Calle T3MP1 D
ia.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit # n
b : `
ProjeccAdd eess: 5101 0 5 i6gO1 LS 1 LWOW
A P. Number tv Ap (
OwnWsName:. Gt
Address:,
Legal Description:
Contractor. G 4HA k 2C,S 'SIJ
City. ST, Zip: i,,'Clec ezLk c- t co, C12 77 y
Telephone: -7 s -q - i Lim
PrejectDescription: STV
1 V (- 0 F,T c'Y
Address: t)C S. ilA'i 0.l ✓
City, ST, Zip: t tPVtr--P GkY Cs . -00,2 3v1
Telephone: -%4 - 9" _ (1110;
State Lit # : "i 50 9 5-7a Lic. >;
.Designs n Cc r,-\S*uk -
-?-UO,G-VL . LJaA, 0.t
S • v'.i e G
Lo . lC6
Address: 'I dab Aqo Li C 'k,. ' "
fro t t
City, ST, Zip: L( , CCL
Telephone: (r,0 `11 - 0'i 3 Construction Type:Occupancy: SIP t
State Lic #: Project type (circle one): Add'n Alter Repair Demo
Name of Contact Person: l S \ ; (,} Z Sq. Ft.. # Stories: # units -
Telephone # of Contact Person: —%Ap` Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Plan Sets
Req'd'Ree'd
TRACMG PERMIT' FEES '
Plan Cheek submitted Item Amount
Structural Cides.
Reviewed, ready for corrections Plan Check Deposit. .
Truss Cales.
Called Contact Person Plan Check Balance
Title 24 Cates.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mecharilcal
Grading plan
V Review, ready for correctionVissue Electrical
Subeontector List
Called Contact Person Plumbing
Grant Deed
Pians picked up ML
ELO-A- Approval
Plans resubmitted Grading
IN ROUSE:-
''+Review; ready for correetionslissue Developer Impact Fee
Planning Approval.
Called Contact Person A.LP.P.
Pub. Wks. APpr
Date of permit issue
School Fees
Total Permit Fees