13-1063 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN: ,'
Application description
Property Zoning:
Application valuation:
Applicant:
13-00001063
45245 SEELEY DR UNIT 17
604-040-999-2 -31116
REMODEL - RESIDENTIAL
TOURIST COMMERCIAL
2000
i
Tili� 4��
/= � VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT v INSPECTIONS (760) 777-7153
BUILDING PERMIT
Owner:
E DOLPHIN LA QUINTA
18818 TELLER AVE #200
C/O DOLPHIN PARTNERS INC
IRVINE, CA 92612
Architect or Engineer:
------------------
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: 13 — l License No.: 975443
r
Date:f'Contractor: r T LiPX
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.). ..
(_) 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:
LQPERTIIT
Date: 8/26/13
Contractor:
FRONTIER WEST BUILDERS I AUG Z 2613
139 BELLINI WAY
PALM DESERT, CA 92211
(760)702-1098 CITyOFEDEPTTA.
Lic. No.: 975443
-----------------------------------------------
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 EXE PT 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 s s to become subject to the workers' compensation laws of California,
and agree that, if, I sho d become subject to the workers' compensation provisions of Section
3700 of the Labor Cod I shall f rthwith`com ly with those provisions.
Date: Applicant:
i
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 1 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 build' construction, and hereby authorize representatives
of this county to enter upon the above-mentioned propert or inspect; n p irposes.
.Date: Signature -(Applicant or Agent):
Application Number . . . . . 13-00001063
Structure Information OPTION 1 - LAUNDRY HOOKUPS AT TOILET RM
Other struct info . . . . . CODE EDITION
7 ------------------------------------------------------------------------
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
----------------------------------------------------------------------------
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 8:44:16 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
LQPERMIT
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Building Penmlt Application and Tracking Sheet F�4
Permit # .
t3• to�a3.
Pmje aAddrew Aaf SESi,
A.P.Numbcr:
A&Iress: I%%%% bum Ave. 2Aa
City, ST, Zip: = V I N 2: C A '9 Z& 12
Legal Description:
Contractor: / (,� j 8vi t,a
Adder 3 IbIELLINI WAY
Telephone: -
Pmjectnemripaon:
City, ST, zip: ACA'92-Sit
Telephone:' , -
State Lia #: 7t 43 City Lic. #; O O r0
Apipt;J V
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Arch., BW, Dedfper.
Address:
City, ST, Zip:
Telephone: %O O ; -O
State Lia #:
Name of Contact Prrson A-� 1. T
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Construction TYPE . 0=Pan7"• .
Pwjeet type (circle one): Now Add'n Repair Demo
Sq. Ft : #Stories: # Uniw
Telephone # of Comact Person
Estimated Value of Project: Qt�Q
APPLICANT: DO NOT WFM BELOW THIS LINE
is
Submittal
ReVd
Recd
TRACMG
PERN[rT FEES-
Plon Sets
,
Pian Check submitted
Deal Amount
Structural Coles
Reviewed, ready for corrections
Pian Cb.=k Deposit...
'l7rust Calea.
Caged Contact Persson
Pian Cheek Balance_
Me 24 Odes.
Pians picked up
ConatM d n
Flood ptatu plan
Piaw resubmitted.'.
Mechanical
Giading plan
-
,
Z' Review, ready for correctionsftssue
Eit ebieal
Subeontector List
Carted CuntaetPeason
Ph=bing
Grant Deed
Pians picked op
S.M.I.
H.O.A. Approval
Plans resabmttted
Grading
IN MUM.
"Review, ready for correctionailwag
Developer Impact Fee
Planning Approval-
Calleed ContactPerson
A.LP.P. '
Puy), WkL Appy -
Date of permit issue
`
School Fees
Temd Pump Fees