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12-1029 (RER)P.O. BOX 1504 t 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 12-00001029 Property Address: 45245 SEELEY DR UNIT 19 B APN: 604-040-999-2 -31116 - Application description: REMODEL - RESIDENTIAL Property Zoning: TOURIST COMMERCIAL Application valuation: 2000 Ti,ht 4 4 Q" Applicant: Architect or Engineer: ------------------- 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 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: L Contractor: 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 (55001.: (_) 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 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 _ 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: LQPERMIT Owner: DOLPHIN LA*QUINTA 18818 TELLER AVE #200 C/O DOLPHIN PARTNERS INC IRVINE, CA 92612 Contractor: D SCHLICHT CONSTRUCTIO 80207 MARAMAR DRIVE BERMUDA DUNES, CA 92'03 (760)702-1048 Lic. No.: 901161 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date:, 9/07/12 e D SEP 12 2012 dUIf4TA ----------------------------------------------- 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 EXEMPT Policy Number EXEMPT 1 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 'I�/-(,�J/337700 of the Labou/r , all forthwith comply with those provisions. Date:C�/ ! "L Applicant: ..// 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 15100,0001• 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 relatingtobuilding construction, and hereby authorize representatives of this (county � to center upon the above-mentioned propert 'section purpo� _ Date: /may 1_A-6ignature (Applicant or Agent): ��� Application Number . . . . . 12-00001029 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 b 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 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 ENERGY REVIEW FEE 2.93 STRONG MOTION (SMI) - RES .50 LQPERMIT - -ti..-,, Application Number . . . . . 12-00001029 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 Irm ff Permit # JC Project Address: i��9$ A. P. Number: Legal Description: Contractor: Address: City, ST, Zip: L9 Qvi n Telephone: -7,r0 jC State Lic. # : Ot 6r. Arch., Engr., Designer: Address: City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: Telephone # of Contact Person: % Estimated Value of Projec APPLICANT: DO NOT WRITE BELOW THIS LINE Recd TRACKING Plan Check submitted Reviewed, ready for corrections Called Contact Person Plans picked up Plans resubmitted tad Review, ready for corrections/issue Called Contact Person Plans picked up Plans resubmitted 'rd Review, ready for corrections/issue -------------------- Called Contact Person Date of permit issue PERMIT FEES Item Plan Check Deposit Plan Check Balance Construction Mechanical Electrical Plumbing S.M.1. Grading Developer Impact Fee A.I.P. P. Total Permit Fees Amount 11