12-0889 (RER)a P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: C 12-006060_889 Owner:
Property Address: 45245 SEE LEY DR UNIT 18 B 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/08/12
Applicant: Architect or Engineer:
Contractor. O
SCHLICHT CONSTRUCTION
/A\ II
!ril t
80207 MARAMAR DRIVE 1
BERMUDA DUNES, CA 92203
�� 0 2012
(760)702-1048
PIP!
LiC. No.: 901161
CITY OF LA QUINTA
FIf�ANGE DEl�T
LICENSED CONTRACTOR'S DECLARATION - -
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations: -
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect._
1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: B License No.: 901161'
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
XD.te:jE)41 ontractor• _rte -
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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
- I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier EXEMPT Policy Number EXEMPT
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and -Professions Code) or
3700 of the Labor Co shall forthwith comely with those provisions.
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).:
te: Applicant:-
(_ 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. -
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.).
(_) 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
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 io 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 workis-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 building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned prop
e ection purposes.
Pete: V ignature (Applicant or Agent):
Application Number.
12-0000088.9
Structure Information
LAUNDRY HOOKUP ADDITION AT MASTER
BATH ----
Other struct info . .
. . . CODE EDITION 2010
Permit . . .
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee
16.50 Plan Check Fee
4.13
Issue Date
Valuation . . . .
0
Expiration Date
2/04/13
Qty Unit.Charge
Per
Extension
BASE FEE
15:00
2.00 .7500
PER ELEC DEVICE/.FIXTURE 1ST 20
1.50
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
45.00 Plan Check Fee
129.25
Issue Date
Valuation . . . .
2000
Expiration Date
2/04/13
Qty Unit Charge
Per
Extension _
BASE FEE
15.00
15:00 2.0000'HND
BLDG 501-2,000
30..00
Permit
MECHANICAL
Additional desc .
Permit Fee . . . .
21.50 Plan Check Fee
5.38
..Issue Date . .
Valuation.
0
Expiration Date
2/04/13
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
2/04/13
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
LQPERMIT
Application Number . . . . .
12-000008.89 '•
-----------------------
Special Notes and Comments
---------------
------------
--------------
WASHER/DRYER HOOKUPS - OPTION
ONE.
.(TOILET ROOM) AS APPROVED IN MASTER PLAN
SET DATED NOVEMBER 8., 2011. 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
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C(tj/ Of Ld QCuth
Buikong 8L Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253-:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit # Q
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Project Address: qS CLi=
A. P. Number.
Owner's Name:.
Address: i S p3 I �f Z 4�20 C)
•
, 1 r.
Contactor. Ll G 1 S' /LC'C
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sin.#
C(tj/ Of Ld QCuth
Buikong 8L Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253-:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit # Q
l
Project Address: qS CLi=
A. P. Number.
Owner's Name:.
Address: i S p3 I �f Z 4�20 C)
Legal Description:
City, ST, Zip; T ✓1 ��q17
Contactor. Ll G 1 S' /LC'C
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'Telephone: �'�rs � �'
one: ~ '- ..
Address:
Project Description:
City, ST, Zip:
Telephone:7GC7 - %O
City Lie..
7
I
J
State Lie. 4: 9 O //a /
Arch., Engr., Designer
Address:
City, ST, Zip:
Telephone: y 'r c
State Lic. #: ..x , w � r
Name of Contact Person:rG/l L 1 corl—
Construction Type' . Occupancy:
Project type (circle one): New Add'n ter Repair Demo
Sq, Ft.: # Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project , 0(n
APPLICANT: DO NOT WRITE BELOW THIS UNE
N
Submittal
Req'd
Recd
TRACMG
PERMIT FEES
Sets
Plan Check submitted
Iter
Amount
Structural Cates
Reviewed, ready for corrections
Plan Chcck Deposit.Truss .
Calcs•Called
Contact Person
Plan Check'Ballance
Title 24 Cates
Plans picked up
Construction
Flood plain plea
Plans resubmitted
Mechanical
Giading plan
2'` Review, ready for correctionstissue
Electrical
Subeontactor List
Called Contact PersonPlumbing
Grant Deed
Plans picked up
S.MJL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^` Review, ready for correetionsfissue
Developer Impact Fee
Planning Approval.
Called Contact Person
A.LP.P. .
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees
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