12-1220 (RER)P.O. BOX 1504
78-495 'CALLE TAMPICO
LA�QUINTA,.CALIFORNIA 92253
Application Number: 12-0000122 0.J..----)
Property Address: 45245 SEELEY DR UNIT 19 H
APN: 604-040-999-2 -31116 -
Application description: REMODEL - RESIDENTIAL
Property Zoning: TOURIST COMMERCIAL
Application valuation: 2000
Applicant:
Tit!t 4 4 Q"
Architect or Engineer:
'
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
P/P/
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.: 901161
ate: �� / ntractor: r
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—) 1, 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 _ ) 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) 7!��012
FAX (760) 777-
INSPECTIONS (760) 777-7153
Date: 10/11/12
Owner:
DOLPHIN LA QUINTA
18818 TELLER AVE #200
C/O DOLPHIN PARTNERS INC
IRVINE, CA 92612
Contractor:
SCHLICHT CONSTRUCT
80207 MARAMAR DRI t J
BERMUDA DUNES, CA 9
(760) 702-1048
Lic. No.: 901161
-----------------------------------------------
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
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 Code, I shall forthwith with those provisions.
te: ��plicant: —
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 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 property fo�ction purposes.
Da to V I!ig ure (Applicant or Agent):
Application Number . . . . . 12-00001220
Permit
BUILDING PERMIT
Additional desc .
Permit Fee . .
45.00 Plan Check
Fee
29.25
Issue Date . . . .
Valuation
. . .
. 2000
Expiration Date
4/09/13
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
4/09/13
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
4/09/13
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 . .
4/09/13
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
Application Number
. . . . .
12-00001220
----------------------------------------------------------------------------
Special Notes and
Comments
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
srrt.#
CIS}/ Of Qtl` to
Bulkang 8r Safety Division
Box 1504, *78-495 Calle Tampico
La.Qutnta, CA 92253 -:{760} 777-7012
Building Permit Applicationand Tracking Sheet
Permit #P.O.
ProjectAddtecs: � s tGt�v y tT
OwneesName:. 1-Jc*-eow LA Qt�iw/T3a.
L.l�•
A P. Number.
Address: 188197 S,LLQt AVt., 6 v 200
Legal Description:
Contractor. 5C*iL1CH7— Go cic o,./
City, ST, Zip: V 1 NZ; 2 (2,1
Telephone: qq'9 — — O
Address: 1
r t cJ
PmjectDescription:
City, ST, Zip: 0,".-a i Qq 922 $3.
Telephone: -160,1)07
State Lie. #: 9 ol Co. C.4 CityLic #: 1 O 01
Ard , Bag., Designer t�tN t
m V
o LxT 00
T
orn 0M oti
Address:
City., ST, Zip:
Telephone:
Construction Type: , oc�upancy:
Project type (circle one): New Add'u Der Repair
Sq. Ft : # Stories: # Unita:
Demo
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person: - 6
Estimated Value of Project: 2_C-_-)Cp0
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
ReWd
Reed
TRAC]MG
PERMMFEFS
Plan Sets
Pian Cheek submitted
%
item
Amount
Structural CaIcs
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Calm.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Pians picked up
Construction
Flood plain plan
Plans resubmitted..
Meebatilcal
Giading plea
2" Review, ready for correctionsressue
Electrical
Subcontaetor List
Called Contact Person
P►wnbing
Grant Deed
Plans picked up
S,M,I,
H.O.A. Approval
Plans resubmitted
Grading
IM ROUSE:-
'" Review; ready for eerreetionalissue
Developer Impact Fee
Planning Approval.
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
R