13-1059 (RER)'P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253
Application Number: 13-00001059
Property Address: 45245 SEELEY DR UNIT 16 B
APN: 6047040-999-2 -31116 -
Application description: REMODEL - RESIDENTIAL
Property Zoning: TOURIST COMMERCIAL
Application valuation: 2000
Applicant: Architect or Engineer:
• �W /�
VOICE (760) 777-7012
+ FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/26/13
Owner:
DOLPHIN LA QUINTA
18818 TELLER AVE #200
C/O DOLPHIN PARTNERS INC
IRVINE, CA 92612 a
' � n
Contractor: �� 1a
FRONTIER WEST BUILDERS INC
139 BELLINI WAY
PALM DESERT, CA 92211 C1 y OF LA QUINTA
.(760)702-1098 FINANCE DEPT.
Lic. No.: 975443
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 Lic/e1nssey1-No.: 975443
` Date: Contractor:%(1�P�
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.).
(_ 1 1, 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 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:
LQPERD1IT
WORKER'S COMPENSATION DECLARATION
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
ed.
ave 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
rtify that, in the perfor ace of the work for which this permit is issued, I shall not employ any
person in any manner s to become subject to the workers' compensation laws of California,
and agree that, if I sho become subject to4.he workers' compensation provisions of Section.
I4r�i1t>o/I3'77000 of the Labor Cod , I shall fortwith comply ith those provisions.
Date:.
�^'T Applicanti
WARNING: FAILURE TO SECURE ORKERS' 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 issuance4ae
or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state ththermation is correct. I agree to comply with all
city and county ordinances and state laws relating toction, and hereby authorize representatives
of this c my t enter upon the above-mentioned prti purposes.
Date: " .1 Signature (Applicant or Agent):
Application Number . . . . . 13-00001059
------ Structure Information OPTION 1 - LAUNDRY HOOKUPS AT
MB -----
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 2/22/14
Qty Unit Charge Per
Extension
1.00 48.6200 LS MISC REMODEL, 1ST 100 SF
48.62
7 ----------------------------------------------------------------------------
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 22, 2013 8:39:16 AM 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
LQPEIN1IT
iiia. #
Citi}/ Of l d Qutn ' .
P.O. Bot 1504,78-495 Cab T3MPr� q UG 21 ?
La.Qidnta, CA 92253 -.-(760) 777-7012 C q7 -y 0F
Building Permit Application and Tracking S�eUN QUI
r
Permit #
Pmject.Addmm:g5245 SEgLZ t .a ",'.16
Vct
OwneesNeme:. ,q � MEQ
A P. Number
Address: ' aa1 a E;L l.�. vg scm,
city', ST, zap: = VIN c C A 9 ?►Co 12
Legal Description:
Couuactar. /
�ViL,ID
Telephone:2.- '-.-
Address. 129 IbELLIN 1
WA
] cmjegDescription: c3el 10
City, ST, Zip= ?ALM QZSt
Telephone:? f7 -
Cq QI 221 t
Wor-ow
�T
State Lic.
Ard , Eng, Designer.
Address:
City, ST, Zip:
• '
Telephone: Ce C0 O ; 'p
Construction Type:. Occupancy:
Statc Lia #:
Name of Contact Person:A'T
Lt T
Project type (aaele one): New Add'n.CX ter Repair Deno
Sq. Ft: # Stories: # Untw
Telephone # of contact Pelson:%( 6EWmaW
Vahm of Project Q �Q
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
sobmitiai ..
RWd
*Reed
TRACMG
P$RM[F FSFS
Pian Sete
Pian Check submitted-
Um Amoma
Structuai Cates.
Reviewed, ready for cormJioas
Pian Check Deposit.
Time Cates.
Called Contact Person
Pian Check Balance.
Title 24 Cates.
Pkm picked up
Construction
Flood plain pian
Plans resubmitted.'.
Mechmiteal
G:mdtng plan
-2 ! Review, ready for correcdons/rrsue
Electrical
$nbeotataetsrI.ist
Gaited CaatactPerson
Ptuatblug ..
Gant Deed
Pians #leked up
s3u
s
tLO.A- Approval
Pians resabmttied
Crading "
V i[om:_
''' Review, ready for eerrecdans/ime
Developer Impact Fee
Planning Approval-
called Contact Person
A".P.
Pab. WkL AW'
Date of permit issue _
School Fees
Total Permit Fees