BLCK (12-0457)51120 Mandarina
12-0457
P.O. BOX 1504
787495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: —'12-000004 57
Property Address: ' 51120 MANDARINA
APN: 776-210-014- -. -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 3500
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
CITRUS GROUP 18, LLC
30875 DATE PALM DRIVE STE. C
CATHEDRAL CITY, CA 92234
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/26/12
Contractor: (f -J t' III'
Applicant: Architect or Engineer- GHA ENTERPRISE, INC. U
30875 DATE PALM DRIVE, -SU= APR 3 0 202
CATHEDRAL CITY, CA 92234
(760)969'1400 05 L.
I ! Lic. No.: 750957 CITY
FIPIANCE DEPT.
-- - - - - -- - - - - -
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
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: 13 =ctor's'State
750957 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
X30,, V-1
issued.
ate: C ractor. ^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
RATION - insurance carrier and policy number are:
I hereby affirm under penalty of a 'ury thatJ '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, 1 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 Code I shall forthwith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
y % any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate: U pplican .
(_ 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 WARNING: FAILURE TO SEC WORKERS' COMPEN TION 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 CRIMI D 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.).. ' APPLICANT ACKNOWLEDGEMENT
(_ 1 'I. as owner of the property, am exclusivelycontracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors'. State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed . 1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). - whose benefit work is performed under or pursuant to any permit issued as a result of this application,
( ) I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency forthe performance. of the.
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
r
Lender's Address: -
LQPERMIT
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 construted hereby authorize representatives
of this county to enter upon the above-mentioned propert pection purposes. '
Date: A ' ra' ignature (Applicant crnt):
LQPERMIT
Application Number . . . . . 12-00000457
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 63.00 Plan Check
Fee
.00
Issue Date Valuation
. . .
. 3500
Expiration Date 10/23/12
Qty Unit Charge Per
Extension
BASE FEE
45:00
2.00 9.0000 THOU BLDG 2,001-25,000
18.00
- ----------------------------------------
Special Notes and Comments
TOTAO OF140 L.F. 6' GARDEN WALL,CITY
STANDARD. 2010 CODES.
----.-------------------
Other Fees . ... . . . . . . BLDG STDS ADMIN (SB1473)
.
1.00
Fee summary Charged Paid Credited
Due
-- ---------- ----------
Permit Fee Total 63.00 .00
----------
.00
63.00.
Plan Check Total .00 00
.00
.00
Other Fee Total 1.00 .00
.00
1.00
Grand Total 64.00 .00
.00
64.00
:. Cid}/ O.f uinta
Building 9. Silky Division .
Permit # . P.O. Box 1504,78-495 Caffe Tampico.
fa.Quinta, CA 92253 -:(760) 7777012
Z. 53 Building Permit Application* and Tracking Sheet
ProjectAddtrss: 5o00" O 66.1040 $ OwneesName:e_- T -r .;f- 1t Grano l:t.L
A P. Number. M {(!Q,i N V 1
. Address: S
Legal Description:-OG1L V;A•\
Contractor.
Address: 14 'lS DIi E.
M4 , ST, Zip:
Telephone:
rr tl.Q, Project Desctiptior(lbao0 l Z$ LW fit' e 1 CLIC
1
City, ST, Zips Qt7a — C_ i . c 0, zz-& c3cPl x-10
Telephone.`y(eob-Ci'(-A -14C 0
State Lia #.:_r5C qS7 7
L SIDgp 14 I -W F7 Bkw_Y. U -+ca. 1 Z
City Lic_ #; 1120 1 10 LN `T $\oe.1L t,► f i
'
Arch., ,resigner Mos eon5oLTih 5101.0) Ion N Fr 8LoCJ _ w 1 2
y!
Address: -TEAM Nit& LA -7
D1VlD'=1J( psJp Q.E. 'V(LtJ Wolff,t$(gyp
i
City., ST. Zip:
• TSL . y sr t ¢.o ..
Telephone: 'J W -111-A O l3 Construction Type: Y, WON ocxupancy: /.
State Lia #: Project type (eirele one): ew Add'n Alter Repair Demo
Name of Con= Person: pat $ Sq. Ft.: # Stories: J # Units:
Telephone # of Contact Person: —%U --et
Estimated Value of Project
.7,` 8.DS
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd .
Rec'd
TRACMG
PERMIT FEES
Plan Sets
Plan Check Submitted
Item Amount
Strgcturai Calm
Reviewed, ready for corrections
Plan Check Deposit.Iyuss .
Cates,
Caped Contact Person
Pian Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted .' .
echanical
Grading plan
2" Review, ready for correctionsrissuecal
Subeontactor List
Called Contact Person
JElectri
umbing
Grant Deed
Plans picked up
M.I.
A.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:.
't° Review; ready for correettonsAssue
Developer Impact Fee
Planning Approval.
Called Contact Person
AIX.P.
Pub. Wks. Appr
Date of permit issue
School Fees I
Total Permit Fees