13-0985 (RER)-'mo-
4
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO �r FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT �—%— INSPECTIONS (760) 777-7153
BUILDING PERMIT ��;;/
Date: 8/07/13
Application Number: 13-00000985 Owner:
Property Address: 45245 SEELEY DR UNIT 16 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
Contractor:
Applicant: Architect or Engineer: SCHLICHT CONSTR /Q
45155 DESERT VI OURT
LA QUINTA, CA 5 v
04
�A Lic . No? :1901 61 ,, 02,
,Z��J
�— C/rynp J
F/n,•, k� cif i _
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.; 901161
tr Date: Q/oC f 110 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 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).:
(_) 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.).
(_) 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
. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — _ _ _ — — — — — — —
WORKER'S COMPENSATION DECLARATIO
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
}}nnsurance carrier and policy number are:
Carrier EXE)IPT Policy Number EXEMPT
I certify that, in the perfarman9e- f the work for which this permit is issued, I shall not employ any
person in any manner so a to ecome subject to the workers' compensation laws of California,
and agree that, if I should a me subject to the workers' compensation provisions of Section
_� of the Labor Code all forthwit omply with thos provisions.
KDate: Applicant:
WARNING: FAILURE TO SECURE W ERS' 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 per it, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the bov information is correct. I agree to comply with all
city and county ordinances and state laws relating to buildi g ristruction and hereby authorize representatives
of thiscco^my t enter upon the above-mentioned property r inspection rposes.
CDate:" d� Signature (Applicant or Agent):
Application Number . . . . . 13-00000985
------ Structure Information OPTION 3 - LAUNDRY HOOKUPS AT
TOILET RM -----
Other struct info . . . . . CODE EDITION
----------------------------------------------------------------------------
2010
Permit REMODEL 2013
Additional desc .
Permit Fee . . . . 48.62 Plan Check Fee
.00
Issue Date . . . . Valuation
0
Expiration Date 2/03/14
Qty Unit Charge Per
Extension
1.00 48.6200 LS MISC REMODEL, 1ST 100 SF
48.62
--=--------=----------------------------------------------------
Special Notes and Comments
------------
WASHER/DRYER HOOKUPS - OPTION ONE
(TOILET ROOM) AS APPROVED IN MASTER PLAN
SET DATED JULY 2013. 2010 CALIFORNIA
BUILDING CODES.
August 7, 2013 3:04:16 PM AORTEGA
-----------------------------------------------------------------'-----------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, REMODEL
132.99
STRONG MOTION (SMI) - RES
.50
Fee summary Charged Paid Credited
Due
---------------------------------------------------------
Permit Fee Total 48.62 .00 .-00
48.62
Plan Check Total .00 .00 .00
.00
Other Fee Total. 134.49 .00 .00
134.49
Grand Total 183.11 .00 .00
183.11
LQPERMIT
RECEIVED
13,r,.#
Qt}/ Of La QuInta
Bo((d(ngarSafety D(als(on CITY OF LA QUINTA
P.O. Box 1504,"78-495 Calle Tamp(co OMMUNITY DEVELOPM T
La Quinta, CA 92233 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
1?s • e9gS
Project AddressA457-45 Seg 9 •7i� 1 G/ -4^S
.
A P. Number.
F:A7ddrcss:V
Legal Description:,,
Contractor: S -2 C -(C Co v ' ��
Telephone: - 85'2 - `{ 2 3 a 3
Project Description: pn,J
Address:L{�/SJr ��S T�/1E� G -Tr
City, ST, Zip: Liq CSZt>) Tzz-o .
Telephone: 760 .l t-zGT
State Lic. # : ty Lia #,
Arch., Engr., Designer. Wl G eN41A1
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of contact Person: A -r ..fir H1_1 C
Construction Type:. Occupancy:
Project type (circle one): New Add'n (�gD Repair Demo
Sq. FG:
# Stories: J # Unit,s:
Telephone # of Contact Person:
Estimated Value of Project" ZQ O O
APPLICANT: DO NOT WRITE BELOW THIS UNE
# Submittal Req'd Recd TRACKING PERMIT FEES
Plan Sets
Plan Cheek submitted
734 Item Amount
Stmetural Calm
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calca.
Called Contact Person
Pian Check Balance.
Title 24 Calci.
Plans picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Giading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Pians picked up
S LL
H.O.A. Approval
Plans resubmitted
Grading
IN KODSE:-
"" Review; ready for correcd a
vdoper Impact Fee
Planning Approval.
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees