12-1254 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
12-00001254
45245 SEELEY DR UNIT 15 H
604-040-999-2 -31116 -
REMODEL - RESIDENTIAL
TOURIST COMMERCIAL
2000
Architect or Engineer:
P/.Apr
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.
Licepe Clasp: B License No.: 901161
ate: �a� iZ�ractor. ae��
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 1$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.).
(_) 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—) 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 ISec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
DOLPHIN LA QUINTA
18818 TELLER AVE #200
C/O DOLPHIN PARTNERS INC
IRVINE, CA 92612 ( —
D
Contractor:
SCHLICHT CONSTRUCTION
80207 MARAMAR DRIVE
BERMUDA DUNES, CA 92203
(760)702-1048
LiC. No.: 901161
i
—"y /
VOICE (76 -/::7012J
/=7012
FAX (760) 7 -
INSPECTIONS (760) 777-7153
Date: 10/22/12
LAA U
cVT242012
LA
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have andwill 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, I shall forthwith comply with those provisions.
ea't a I nt: —�
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 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 1 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 y ounty to enter upon t above-mentioned prope ection purposes.
7__: Si ature (Applicant or Agent):—"'"—��
LQPERMIT
Application,Number
12-00001254
Permit
BUILDING PERMIT
Additional desc
Permit Fee . . . .
45.00 Plan Check
Fee
29.25
Issue Date . . .
Valuation
.
. 2000`
Expiration Date
4/20/13
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
4/20/13
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
4/20/13
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
4/20/13
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
----------------------------------------------------------------------------
Special Notes and Comments
WASHER/DRYER HOOKUPS-
OPTION ##1 (TOILET
ROOM) AS APPROVED IN MASTER PLAN SET
LQPERMIT
t
LQPERMIT
Application Number
. . . . .
12-00001254
----- ----------------------------------------------------"-----------
'Special Notes and
Comments
DATED NOVEMBER 8,
2011, 2010
CALIFORNIA
BUILDING CODES.
--------------------------------------------------
Other Fees .
. . . . . .
BLDG STDS ADMIN
--------------------------
(SB1473)
1.00
ENERGY REVIEW
FEE
2.93
STRONG MOTION
(SMI) - RES
.50
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
4.43
.00
00,
4.43
- Grand Total
156.19
00.
.00 '.
156:19
t
LQPERMIT
i
I
I.
. Bin. #
'
cityOf %d Ulfltd lr
Q
Building U Safety Division
Permit #
P.O. Box 1504,'78-495 Calle Tampico
14.Quinta, CA 92253 - (760) 777-7012
j
Building Permit Application and Tracking Sheet
Project Address. 2,4S
(S 'Owner's Name
i A. P. Number.
Address: t✓ _
Legal Description:
City, ST, Zip:
Contractor Ucf/T CDI�/ C-7) a'~, Telephone: - �Z -9'Z a
i
>.;,..r`:,:�&.>'rs�is•K:x
Address: S� G
lEu� Project Description:
City, ST, Zap_ G0M,/Z)9
o
1 Telcplone-760 _p
O Zv 10
ct4, 1 J'
�C Vii"<• r n
f. � d �i<%lea'" , r MKIi r
mGp 0,V
State Lia # : O (ate
City Lic. #t i �'
' Arch., Engr., Designer
N
Address:
City, ST, Zip:
Telephone:
Y Construction Type:. Occupancy:
State Lie. #:
:�' ��`�
".:wis»ia:.; Project type (circle one): New Add'n ter Repair Demo
Name of Contact Person: �E�-T-
&-44 L f Gif T Sl FL:# Stories: #Units:
j Telephone # of Contact Person: -
Estimated Value of Project ZO.v "
i
APPLICANT: DO NOT WRITE BELOW THIS UNE
# Submittal Req'd
Recd TRACKING PERMfi FEES
Pian Sets
Plan Check submitted it. Amount
Structural Calcs.
Reviewed, ready for corrections Plan Check Deposit. .
Truss Calci•
Called Contact Person Pian Check Balance"
Title 24 Calci.
Plana picked up Construction
Flood plain plea— —
---Plaai-resubmitted " —-Nlechariical —_ .—
Giadiug plan
2i° Review, ready for correctionstiissue
Electrical
Subcoatactor List
Called Contact Person
Plumbing
Grant Deed
Pians picked up
S.M.I.
H.O A Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review; ready for correcdonemue
Developer Impact Fee
Planning Approval.
Called Contact Person
A.LP.P-
Pub.Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees
_ .... ......... -............ .. ... ......... .