13-0254 (RER)`- ` — P.O. BOX 1504
r 78-495 CALLE TAMPICO
r LA QUINTA, CALIFORNIA 92253
Application Number: 13-00000254
Property Address: 45245 SEELEY DR UNIT 16
APN: 604-040-999-2 -31116
Application description: REMODEL - RESIDENTIAL
Property Zoning: TOURIST COMMERCIAL
Application valuation: 2000
4���VINW -
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Owner:
E DOLPHIN LA QUINTA
18818 TELLER AVE #200
C/O DOLPHIN PARTNERS INC
IRVINE, CA 92612
Applicant: Architect or Engineer:
I L-.11 A1114-
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 �Ucenso.: 901161
Dat 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 ($500).:
(_ 1 I,.as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
1 _) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
Date:
3/08/13
Contractor:
SCHLICHT CONSTRUCTION Ip�$e
45155 DESERT VIEW COURT 9 D n
LA QUINTA, CA 92253 B
(760)702-1048 f I'
Lic. No.: 901161
l ur
WORKER'S COMPENSATION DECLARATION` ' --•-- — a,.,�
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.
_ 1 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 1 should become subject to the workers' compensation provisions of Section
3700 of the Labor Chwith com4ly with those provisions.
Date 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 ($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.
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 n
1 . Each person upon whose behalf this app) icatiop,is=mad_ ea,Aeac�h person at-ho..requestiand for
whose benefit work is performed under& � dr'suant to any permit issued�as a resuhloypis application,
the owner, and the applicant, each agreesf to,land shall defend, indemnify an 'hold harm the City
of La Quinta, its officers, agents and em�oyees for any'act or omission related to t fe
work being
performed under or following issuance"of thisf permit. % ���a / �II
2. Any permit issued as a result of this application becomes null and�voidit w9rk is not,cpmmenced
within 180 days from date of issuance of such -permit, -or cessation of work for(1,80ldays will subject
permit to cancellation. '� .'°�,p 11
I certify that I have read this application and state that•the above information is�correct_ I agree to1comply with all
city and county ordinances and state laws relating to building construction,ar'd hereby authorize t representatives
of this county to enter upon the above-mentioned prop,o_p purposed-_
Date: 3 / Signature (Applicant or Agent):
LQPERMIT
Application Number . . . . . 13-00000254
Permit BUILDING PERMIT
Additional desc .
Permit Fee . . . . 45.00 Plan Check
Fee
29.25
Issue Date . . . . Valuation
. . .
. 2000
Expiration Date . . 9/04/13
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 . . . . 15.75 Plan Check
Fee
3.94'
Issue Date . . . . Valuation
0
Expiration Date 9/04/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 .7500 PER ELEC DEVICE/FIXTURE IST 20
----------------------------------------------------------------------------
.'75
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 21.50 Plan Check
Fee
5.38
Issue Date . . . . Valuation
. . . .
0
Expiration Date 9/04/13
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 9/04/13
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 ONE (TOILET
ROOM) AS APPROVED MASTER PLAN SET DATED
LQPERMIT
LQPERMIT
Application Number
. .
13-00000254
-----------------------------------------------------=
Special Notes and Comments
----------------------
NOVEMBER 2012. 2010
CBC.
----------------------------------------------------------------------------
Other Fees . . . .
. . . . .
BLDG STDS ADMIN
(SB1473)
1.00
ENERGY REVIEW
FEE
2.93
Fee summary
Charged
Paid
Credited
Due
Permit Fee Total
106.25
.00
.00
106.25
Plan Check Total
44.57
.00
.00
44.57
Other Fee Total
3.93
.00
.00
3.93
Grand Total
154.75
.00
.00
154.75