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13-1060 (RER)T4&t 4 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 13-00001060 Owner: Property Address: 45245 SEELEY DR UNIT 16 H 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 L Contractor: Applicant: Architect or Engineer: FRONTIER WEST BUILDERS INC 139 BELLINI WAY PALM DESERT, CA 92211 (760)702-1098 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 License No.: f9�7-5443 Date: ia_ Contractor:-Rpn�frwI s �, 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.). (_ 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: LQPERp11T VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/26/13 AUG 2 CI 2013 CITY OF LA QUINTA FINANCE DEPT. WORKER'S COMPENSATION DECLARATION 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 insurance carrier and policy number are: Carrier EXEM T Policy Number EXEMPT certify that, in the performance of the work for which this permit is issued, I shall not employ any _ person in any manners? to become subject to the workers' compensation laws of California, and agree that, if I shou .come subject to the workers' compensation provisions of Section 3700 of the Labor Cod I shall forthwith Fomply ith those provisions. Date: _ Applicant: Ala WARNING: FAILURE TO SECURE RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the o e information is correct. I agree to comply with all city and county ordinances and state laws relating to buildi g onstruction, and hereby authorize representatives of this co my t enter upon the above-mentioned property r inspection urposes. Date: (3 Signature (Applicant or Agent): w Application Number 13-00001060 ------ Structure Information OPTION 1 - LAUNDRY HOOKUPS AT TOILET RM ----- Other`struct info . . . . . CODE EDITION ----------------------------------------------------------------------- 2010 ------ Permit . . . REMODEL 2013 Additional desc . Permit Fee . . . . 48.62 Plan Check Fee .00 Issue Date . . . . Valuation . . 0 Expiration Date 2/22/14 Qty Unit Charge Per Extension 1.00 48.6200 LS . MISC REMODEL, 1ST 100 SF 4$.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 22, 20138:40:35 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 LQPERMIT ' City. of La Quinta 6,91 BAft at safely Di won?�13 co, _ Co M(/tn' op P.O Box 1504,'78-495 Calle Tampfc+o FUIj�T ia.Qddttta, CA 92253 - (760) 777-7012 �j� Building Permit Applicadon and Tracking Sheet, ' VF4oPiy % Perintt Project.A(dtess: � ` 24St SF.aF 16) %i• owner's Name:.A A.P.Number Address: 'a�,� - t�ilC- V01lAi'O City, ST, Zap: = VINs: C.A '92-412- Telephone: 2.- 23p Leeal Description: Contractor /it.OE Address: 3 • E LLI 1 WAY Pried Description: © l O � City, ST. Zip: ?ALM DES't ACA 9 ZZ l Telephone State Lia #: 3 Cety Lla P; O Oro Arch., Bngr., Designer ApIDw Address. CHN ST, Zip: " (0 0 p Telephone: Constcudion Types , . Ooargancy: State Lia #: Name of Comalx Person• A'r l.t T Project type (circle one): New Add'n oer Repair Demo S4• #Stories: # Unitp: Telephone # of Colfta Bstimaw Value of Project: QOp APPLICANT: DO NOT WRITE BELOW THIS UNE ' Submittal IRWd Itee'd TRAQ�TG PERMI'FFEFS- Plan Sete Pian Check submiued Dem Amount S"duial Cases. ' . Reviewed, ready for cowecdoffi Pian Check Deposit, . Truss Cates. Called Coatkd Person Plan Chalk Balance. Mae 24 Cates. Plane picked up Construction Flood plain plan Pians resubmitted •' . Meaharittil Giadtn plan 2" Review, ready -foi correctionsikasue Electrical 8nbcoatactorI3st CalledContactPersoa Plumbing. Grant Deed Plans picked up ;. + S.bU H.O.A. Approval Plans resubmitted Grading IIsi BOl33S:- '� R4vtev; ready for eorrecdouslissue Devdoper Impact Fee Planning Approval' Called Coataet Person Pub- Wks Appy • Date of permit issue School Fen Total Permit Fees I 'j I