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12-1026 (RER)P.O. LOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 12-00001026 Property Address: 45245 SEELEY DR UNIT 18 H APN: 604-040-999-2 -31116 - Application description: REMODEL - RESIDENTIAL Property Zoning: TOURIST COMMERCIAL Application valuation: 2000 Tiht 4 4 4" Applicant: Architect or Engineer: 17A -------------- 2-1 LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with r 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 Date: I // 1 "L11/l_,,Contractor. .�— TT�"T 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.). ' I—) 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 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/07/12 Owner: DOLPHIN LA•QUINTA 18818 TELLER AVE #200 D a C/O DOLPHIN PARTNERS INC D IRVINE, CA 92612 ��IL t.� 2 Contractor:I.AQf�)1iA SCHLICHT CONSTRUCTION FINANCE XPi' 80207 MARAMAR DRIVE BERMUDA DUNES, CA 92203 (760)702-1048 Lic. No.: 901161 ----------------------------------------------- WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury one of the following declarations: - 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 I should become subject to the workers' compensation provisions of Section 3700 of the Labor Cod II forthwith comply wi those provisions. Date: �ZApplicant: �� WARNING: FAILURE TO SECUR- 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, indemnity 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 it 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 building construction, and hereby authorize representatives of this county to enter upon the above-mentioned propert or inspection purposes. Date: �I-Signature (Applicant or Agent„ —� a''� :►moo Application Number . . . . . 12-00001026 Permit BUILDING PERMIT Additional desc . Permit Fee 45.00 Plan Check Fee 29.25 Issue Date . . . . Valuation . . . . 2000 Expiration Date,. 3/06/13 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 3/06/13 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 3/06/13 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 .3/06/13 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 #1 (TOILET ROOM) AS APPROVED IN MASTER PLAN SET LQPERMIT LQPERMIT Application Number .. . . . . 12-00001026 ---------------------------------------------------------------------------- Special Notes and Comments DATED NOVEMBER.8, 2011. 2010 CALIFORNIA BUILDING CODES. ----------------------------------------------------------- Other Fees . . . . . . 7 ---------------- 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 Bin. # Permit # Project Address: 4TT j ' A. P. Number.'71StJ� of La Quinta Building 8t Safety Division P.Q. Box 1504,78-495 Calle Tampico [a-Writa, CA 92253 -:(760) 777-7012 Building Permit Application and Tracking Sheet J Owner's Name:. N/ Address: Legal Description: Contractor. CN City, ST, Zip. Zoo m Telephone: 94 Q - 802 (> Address: /SS Mss�c I Project Description: – City, $T, Zip: LrX� Telephone: 76o x7a Z - 04Al State Lia #: p / Arch, Engr., Designer City Lie. #; lne2s > Address: City., ST, Zip: Telephone: State Lia #: Construction Type:. Occupancy: Project type (circle one): New Add'n Repair Demo Sl• Ft: #Stories: #Univ: Name of Contact Person: 3et..t- s c—H (ilG/`J' T Telephone # of Contact Person: %(� Estimated Value of Project Q-� APPLICANT: DO NOT WRITE BELOW THIS LINE 11 Submittal Req'd Recd TRACE NG PERMIT FEES Plan Sets Plan Cheek submitted Item Amount Structural Calls. Reviewed, ready for corrections Ptah Check Deposit. . Truss Cala. Called Contact Person Plan Check Balance Tithe 24 Coles. Plans picked up Construction Flood plain plan Pians resubmitted.'. Mechafilcal Grading plan Z'! Review, ready for correctionstissue Electrical Subeontactor List Called Contact Person Plumbing Grant Deed Plans picked up. ML H.O.A. Approval Plans resubmitted Grading IN ROUSE:- ''' Review; ready for eorreetionslissue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit Issue School Fees Total Permit Fees