12-0234 (RER)P.O. BOX 1504 4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: �712Y-0000023471 Owner:
Property Address: 45245 SEELEY DR' UNIT 15 A DOLPHIN LA QUINTA
APN: 604-040-999-2 -31116 - 18818 TELLER AVE #200
Application description: REMODEL - RESIDENTIAL C/O DOLPHIN PARTNERS INC
Property Zoning: TOURIST COMMERCIAL IRVINE, CA 92612
Application valuation: 2000 0 I
II I ontractor:
Applicant: Architect or Engineer: ! CHLICHT CONSTRUCTION
LLLLJIII
MAR 1 C 202 �
80207 MARAMAR DRIVE
tERMUDA DUNES, CA 92203
IA- r Gid'"1�C;�.A'."�JiP1ii►
L 760)702=1048
iC No.: 901161
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: BL ic�141 901161
atei!% 2tYL ntractoc ,�IGIS► G��1T�AJduTT�✓� 0 ��
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 ($500).:
(_ 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.).
(_) 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 _ 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
.Date: 3/15/12
i
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 Code, l shall forthwith with those provisions.
9aia: 6 Applicant: *_ c_ '
/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 co ter upon the above-mentioned proms pection pur
aD te: 3 16 L ure (Applicant or Agent) ��
Application Number . .. . . . 12-00000234
------ Structure Information LAUNDRY HOOKUP ADDITION AT MASTER BATH -----
Other struct info . . . CODE EDITION 2010
---------------------------------------------------------------------------
Permit . . .
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . .
16.50
Plan Check Fee
4.13
Issue Date,
Valuation
0
Expiration Date
9/11/12
Qty Unit Charge
.Per
Extension
BASE
FEE
15.00
2.00 .7500
--------------------------------------------------------------------------
PER , ELEC'DEVICE/FIXTURE
--
1ST 20
1.50
Permit BUILDING PERMIT
Additional desc
Permit Fee
45.00
Plan Check.Fee
29.25
Issue Date
Valuation
2000
Expiration Date
9/11/12
Qty Unit Charge'
Per
Extension
BASE
FEE
15.00
15.00 2.0000
---------------------------
HND BLDG
-------------------------------------------------
501.-2,000
30.00
Permit. . MECHANICAL .
Additional-desc .
Permit Fee
21.50
Plan Check Fee
5.38
Issue Date
Valuation
0
Expiration Date
9/11/12
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 6.5000
----------------------------------------------------------------------------
EA MECH VENT FAN
6.50
Permit . . . PLUMBING
Additional desc . .
Permit Fee . . . . 24.00
Issue Date
Expiration Date 9/11/12
Qty Unit Charge Per
Plan Check Fee .
Valuation
BASE FEE
1.00 6.0000 EA PLB FIXTURE
1.00 3.0000 EA PLB WATER INST/ALT/REP
LQPERMIT
6.00
0
Extension
15.00
6.00
3.00
LQPERMIT
Application Number . . . . .
12-00000234
----------------------------------------------------------------------------
Special Notes and Comments
WASHER/DRYER HOOKUPS - OPTION
ONE
(TOILET ROOM) AS APPROVED IN MASTER PLAN
SET DATED NOVEMBER 8,.2011. 2010
CALIFORNIA BUILDING CODES.
------------------------------------------------
Other Fees . . . . . . .
-
BLDG STDS ADMIN
---------=-----------------
(SB1473)
1.00
ENERGY REVIEW
FEE
2.93
Fee summary Charged
Paid
Credited
Due
Permit Fee Total 107.00
.00
.00
107.00
Plan Check Total '44.76
.00
.00
44.76
Other Fee Total 3.93
.00
.00
3.93
Grand Total 155.69
.00
.00
155.69 '
LQPERMIT
Bin #
Permit # `
1 d
Project Address:
v
Cray of La Qutnta':
BuikOng d SafetyDivision ,
P.O. B®x.!504, 78-495 Calle-Tampico
ta.Quinta, CA 92253 - (760) 777 7012
Building Permit Application and Tracking Sheet
CSL I ✓� Owner's Name:. L ��
A. P. Number.
Address: / L G
Legal Description: iT'IS
City, ST, ZrP• (%/ 2!c / 2
Contractor. SZY—C
!qo v Off.
Telephone:
Address.
�� ��
Project Description:
City, ST, Zip: QtJ
Cg �22 53
�/`�G L C7b0 c>
Telephone: 7(p , p ¢ 8
/OA/
State Lie. #
City Lie.. C -
Arch, Eng., Designer:
Address: 2
Gt/H
City., ST. Zip:
Telephone:760
State Lic. #:
r
Name of Contact Person: -r x/ �G! c�7—
Construction Type:. Occupancy:
Project type (circle one): New Add'n ter Repair Demo
Sq. FL:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated value of Project: 2, fa0 C7
# Submittal Req'd
Plan Sets
APPLICANT: DO NOT WRITE BELOW THIS. UNE
Reed TRACMG PERMfI' FEES
Plan Check submitted Item Amount
Structural CaIcs.
Reviewed, ready for corrections Plan Check Deposit. .
Truss Cales.
Called Contact Person Plan Check Balance
Title 24 Calcs.
Plans picked up Construction
Flood plain plan,
Plans resubmitted.. Mecharilcal
Grading plan
2' Review, ready for correctionsl'issue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up t SMI.
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE.-
''d Review; ready for correctionslissue Developer Impact Fee
Planning Approval
Called Contact Person A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees