12-0026 (RER)4 P.O. BOX 1.504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Application Number: 1-2-00000026_
Property Address: 45245 SEELEY DR UNIT 15 B
APN: 604-040-999-2 -31116 -
Application description: REMODEL - RESIDENTIAL
Property Zoning: TOURIST COMMERCIAL
Application valuation: 2000
Applicant: Architect or Engineer:
ls� a tn�Q "4 -
LICENSED CONTRACTOR'S DECLARATION
-I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 91commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License CI a s: B :cense No.: 901161
X Date: Contractor
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 fie 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).:
(_) 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 _ 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.).
(_) 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
Date: 1/10/12
Owner:
DOLPHIN LA QUINTA
18818 TELLER AVE #200
C/O DOLPHIN PARTNERS INC
IRVINE, CA 92612
Contractor: D e I�
SCHLICHT CONSTRUCTI s q
80207 MARAMAR DRIVE- JAN' 1 � 2012
BERMUDA DUNES, CA 9 0
(760) 702-1048 CITYOFI.AQUINTA
Lica No.: 901161 �",n-nr
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 s rthwith cgnlWy with those provisions.
KDate: Applicant: -
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 1$100;0001. 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.
I . 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 Ic�ouu-nnttyy to -enter upon the above-mentio erty for inspect: urposes.
KDate: J/ / Signature (Applican� enth__.
Application Number . . . . . 12-00000026
Structure.Information LAUNDRY HOOKUP AT MASTER BATHROOM
Other struct info . .
-------------'---------------------------------------------------------------
. . . CODE EDITION
2010
Permit
BUILDING PERMIT
Additional desc .
Permit Fee
45.00 Plan Check
Fee
29.25
Issue Date . . . .
Valuation
2000
Expiration bate
7/08/12
Qty" Unit Charge
Per
Extension
BASE FEE
15.00
•15.00 2.0000
-----------------------------------------------------------------------------
HND BLDG 501-2,000
30.00
Permit . . .
ELECT - ADD/ALT/REM
Additional.desc .
Permit Fee . . . .
16.50 Plan Check
Fee
4.13
Issue Date
Valuation
0 ,
Expiration Date-.
7/08/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
2.00 .7500
PER.. ELEC DEVICE/FIXTURE 1ST
20
1.50
Permit . . .
MECHANICAL
Additional desc .
Permit Fee . . . .
21.50 Plan Check
Fee
5.38
Issue Date . . . . '
Valuation
. .
. . 0
Expiration Date
7/08/12
'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 Plan Check
Fee
6.00
Issue Date . . . .
Valuation
. .
. . 0
Expiration Date
7/08/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 6.0000
EA PLB FIXTURE
6.00
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00
LQPERMIT
Application Number . . . . . 12-00000026
----------------------------------------------------------------------------
Special Notes and Comments
WASHER/DRYER HOOKUPS - OPTION ONE
(TOILET ROOM) AS APPROVED IN:MASTER
PLAN
SET DATED NOVEMBER 2011. 2010
.8,
CALIFORNIA BUILDING CODES.
January 10, 2012 1:23:17 PM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . ... . . . . BLDG
STDS ADMIN (SB1473)
1.00
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 1.00
.00
.00
1.00
Grand Total 152.76
.00
.00
152.76
LQPERAI IT
Bin # . " . ..
... _, . .. City of La Quinta
Building 8t Safety Division. "
P.O. Box 1504, 78-495 Calle-Tampico t
Quinta, CA 92253 - (760) .777-7012 "
Building Permit Application and Tracking Sheet
Permit #
Project Address: 4s2,45- L L (5
Owner's Name:
A. P. Number: b _ 04-0
Address: 1 s LL V O O
Legal Description:
Contractor:L /G/-ro /�Je7> o �✓
City; ST, Zip:
�#':
lephone:TeMEMOS
Address:Q.S I V
Project Description:
City, ST, Zip:Log Qc-,,l t -/ CA C2rZ.S7
Telephone:760- 02 - /CJ
State Lie. # : clot 16 1
City Lie. #:
Arch., Engr., Designer:
/
Address: Man ��
p
City, ST, Zip: P/3trrl.T Cj3 q2 -Z 6�
Telephone:34, 0 -19 00,Eyw z: : '"> •'
{"� 2.tfm�.a^ii �iird'fA.6p,C� W„
State Lie. #:
Name of Contact Person: iS HL /G/*7-
Construction Type: Occupancy:
Project circle one): New Add'n eer Repair Demo
Sq. Ft.:
# Stories: A
# Units:
Telephone # of Contact Person: _-�
Estimated Value of Project: 2Q p
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rec'd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted'
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calls.
Called Contact Person
Plan Check Balance
Title 24 Gies.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
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