13-0148 (RER)4 P.O 1BOX 1504 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
Date: 2/11/13
Application Number: .��'1300148 T Owner:
Property Address: '45245 SEELEY DR UNIT 16 F 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 CONSTRUCTION
80207 MAR.AMAR DRIVE
VFINANCE
BERMUDA DUNES, CA 92203
(760)702-1048
1013
Lic. No.: 901161 �1.AQUINTA
nFor
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
f��.
Date:a--� Contractor."
JL_
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—) 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 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 DECLARATION
1 hereby ajyrm 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 theperformance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier EXEMPT Policy Number EXEMPT
I 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 becomesubject to the workers' compensation laws of California,
and agree that, if I's Id become subject to the workers' compensation provisions of Section
3700 of the LaborC40, forthwith comply with those provisions.
Date:c;O ILL ' I:JApplicant:1 XVLAL V (/•/ til
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 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 buildi construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property or inspe ion purpose .
1655:�—Signature (Applicant or Agent):`
Application Number . . . . . 13-00000148
------ Structure Information LAUNDRY HOOKUP ADDITION AT MASTER
BATH -----
Other struct info . .
. . . CODE EDITION
2010
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee
45.90 Plan Check
Fee
29.25
Issue Date
Valuation
. . . .
2000,
Expiration Date
8/10/13
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 ,
8/10/13
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
8/10/13
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
8/10/13
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
LQPERMIT
LQPERMIT
Application Number
13-00000148
Special Notes and Comments
WASHER/DRYER HOOKUPS - OPTION
ONE
(TOILET ROOM) AS APPROVED IN MASTER PLAN
SET DATED NOVEMBER 2012. 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
LQPERMIT
Bla #
Oty. Of ' La Quin: to
Building a Safety Division
P.O. Box 1504,78-49S Calle Tampico
CA 92253 -:(760) 777-7012
Building Permit -Application and Tracking Sheet
Permit #
5La.Quinta,
Project.Address
Owner's Name:.
A. P. Number.
Address: 106118
Legal Description:
Contractor
City, ST, Zip;Mfz—yljvG�
Telephone:
Address4
Project Description:
City, ST, Zip: L4 0U//V7)1q 922 -1; --?Q
I C),A/
Telephone:7R
_Z
0 .
V
Xv
State Lie. #: City U C, 9,
(301 C � f!
Arch, Bagn, Designer. lz—(f, 05�A/q
Address:
City., ST, Zip:
Telephone:
State Lic. M
Name of Contact Person:P
AZ—
Construction type: Occupancy:
Project type (circle one): New Add'n( Alter Repair Demo
Sq. . Ft.. —T# —St,,ies: Units:
Telephone # of Contact Person:
Estimated Valite of Project: c) 0
APPLICANT: DO NOT WRITE BELOW THIS LINE
Submittal
Rq9d
Rccld
TRACMG
PERMIT FEES
Plan SetsRem
Plan Check submitted
Amount
Structural Calcs.
Reviewed, ready for corrections
Phu Check Deposit.
Truss C21cs.
Called Contact Person
Plan Check Balance
Tide 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted.'.
Mechanical
Giuding plan
2" Review, ready for correctionstissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
ShLL
H.OA. Approval
Plans resubmitted
Grading'
0i ROME:.
WYlew, ready for carrectio'nsAssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit Issue
SchoW Fees
Total Permit Fees