BELC2015-0062tSE�IONS
(760) ;
78-495 CALLE TAMPICO C� 0 D . 70
LA gUINTA, CALIFORNIA 92253 ("M -
- COMMUNITY DEVELOPMENT DEPARTMENT (760 ;
BUILDING PERMIT OUINTAMENTD I
Application Number: BELC2015-0062 Owner:
Property Address: 51660 AVENIDA OBREGON . ROBYN DOOLEY
APN: 773124008 51660 Avenida Obregon
Application Description: NEW 30A ELECTRICAL FOR SPA ; La Quinta, CA 92253
Property Zoning:
Application Valuation:
1�
Applicant: Contractor: ,
ROBYN DOOLEY OWNER BUILDER
51660 Avenida Obregon
La Quinta, CA 92253
LICENSED CONTRACTOR'S -DECLARATION
I hereby affirm under penalty of perjury that l am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: License No.:
Date: 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
Llc. No.:
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 workerscompensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this permit
is issued. Myworkers' compensation insurance carrier and policy number are:
Carrier'._ Polity Number:_
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 l should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
of the Business and Professions Code) or that he or she is exempt therefrom'and the Date: Applicant:
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' WARNING: FAILURE TO SECURE,WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
($500).: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
( __) I, as owner of the property, or my employees with wages as their sole ONE HUNDRED -THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF `
compensation, will do the work, and the.structure is not intended or offered for sale. COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State. License Law does not INTEREST, AND ATTORNEY'S FEES.
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 applyto an owner of property who builds or Jrnproves
thereon, and who contracts for the projects with a contractors) licensed pursuant to,
the Contractors' State License Law.).
(_J I am exempt under Sec. B.&P.C. for this reason
Date: er.
CONSTRUCTION LENDING AGEN
I hereby affirm under penalty of perjury that there is a co struction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official 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 city to enter u the above-
mentioned property for inspection purposes. 'p�
Signature (Applicant or Age"nij:
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0 $24.17 $24.17 8/14/15
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ROBYN DOOLEY DEBIT
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ROBYN DOOLEY DEBIT
R8498 LUR
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Total Paid forELECTRICAt $48 34 $48.34
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ROBYN DOOLEY
DEBIT
R8498
LUR
y_. " Total Paidlf fpmlt ISSUANCE $91 85
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Description: NEW -30A
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$24.17
Applied: 8/14/2015 LUR
R8498
DEBIT ROBYN DOOLEY
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OTHER ELECTRICAL 101-0000-42403 0
$24.17
$24.17” ..8/14/15
R8498
DEBIT ROBYN DOOLEY
LUR
EQUIPMENT
Printed: Friday, August 14, 2015 1:00:55 PM
-
1 of 2
.SYSTEMS
Permit Details PERMIT NUMBER£
r r City of La Quints RELcloit5 0062`
y
A
P......RENT PROJECTS.
Printed: Friday, August 14, 2015 1:00:55 PM 2 of 2 ,
SYS7Ek1S
STD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
�'y PAID
PAID. DATE
RECEIPT #.
CHECK #
METHOD
PAID BY a
CRY'
.,,.,
d.
tl
OTHER ELECTRICAL
101-0000-42600
0
$24.17
$24.17
8/14/15
R8498
DEBIT
ROBYN DOOLEY
LUR
EQUIPMENT PC
Total Paid forELECTRICAL: $48.34 $48.34
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$91.85
8/14/15
R8498
DEBIT
ROBYN DOOLEY
LUR .
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
A
P......RENT PROJECTS.
Printed: Friday, August 14, 2015 1:00:55 PM 2 of 2 ,
SYS7Ek1S
78-495 CALLE.TAMPICO,
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
(760) 777-7012
FAX (760) 777-7011
Consider ;ng,--aing:4h O'wner=Builder?
Important information you -need to know BEFORE pulling your` permit!
The term "Owner -Builder" -can mean three different things:
"Owner as Worker", "Owner as Contractor". or, ".Owner as Employer"
Understand each -has Benefits or Risk; and it is possible to combine them!
Hiring a California Licensed Contractor, means you do not personally. perform any of the construction work, the permit is not taken
out in your name, you are not personally�responsible for the construction.and you are not. an'Owrier.-Builder. Instead, you become a
"Customer" and California law provides you the benefit of protection from poor workmanship, failure. to finish the job and financial
risk due to worker injury.
BenefitlR4k: Highest Benefits and the Least amount of :Risk
Owner -as -Worker is a type of Owner-Builder•where you personally perform the construction; work, the permit is taken out in your
name and you are personally responsible for the constructionmanagement, knowledge, workmanship, and completion of the job. You
benefit by not paying others to�perforin this work for you and -your -risk depends on your own ability to complete the job successfully.
Benefit/Risk: Possible Benefit with•Low Financial Risk
Owner -as -Contractor is a type of Owner -Builder where you personally act as your own General Contractor, the permit is taken out in
your name and you hire California -licensed -sub -contractors to perform portions'of the•construction work. WARNING: The benefit of
protection provided by law when, you..hire.'.only California licensed sub -contractors; can 'turn to:wn6us financial risk if you hire
unlicensed contractors to perform any'ofthe work. .
Benefit/Risk: Possible Benefit and Significant Financial Risk
Owner -as -Employer is a type of.Owner=Builder where you pay any unlicensed individual oto perform any construction work valued at
more than $500.00, the permit is taken -out in your name and you •are- personally responsible for their employment requirements,
supervision, performance, safety and welfare while on your property. :WARNING: Cost savings benefi{'can turn to serious financial
risk if you fail to deduct payroll taxes or, provide*workers compensation insurance for each worker.
Benefit/Risk: Possible Benefit with Significant Financial Risk
J
(Health and Safety Code Section 19827) The .California .:Legislature declares an "urgent and statewide
public interest in.assuring" that contractors ..comply. with Contractors' .License. Law, Business and
Professions Code and Workers' Compensation Insurance requirements.to ensure property owners are
informed about, and protected from the following when improving their property as Owner=Builders:
Fraudulent representations •,Liability for worker's injuries - Liatility.for material and labor costs unpaid by
contractors •,Licensing requirements - Employers :tax' liabilities
Over 20,000 consumer complaints are filed each.year. Many complaints relate to owner/builder projects
and. include workmanship' and workers' compensation issues Homeowners s iffer:financial harm due to
defective workmanship and. injured employees.
Following are. alarming examples of what has occurred with Owner -Buil ler:permits:
Example 1: Homeowner received insurance moneyl.0 rebuild.buened-down;home.
■ Owner/Builder permit Pulled to rebuild structure:
■ Unlicensed contractor built substandard'structure - must be torn down and, replaced.
■ Estimated financial. injuryis $225;000.
Additional financial injury --IRS threatened to -.tax insurance payout if house not completed by the end of
the year.
Example 2: Brother-in-law hadactive. license- but filed an. exemption from Workers Comp.
• Owner,Builder hires brother-in.'law,,to instal[,a new roof.
■ Employee falls and -sustains iriultipleispinal acid extremity fractures as. well:as a head injury and
remains.ina coma to this day.
■ The Owner -Builder, who�has sold the home, is now a defendant, in a lawsuit for reimbursement for
benefits paid to the injured worker.
Example 3: Employee of contractor without Workers Comp is hired by Owner -Builder to install septic
system and suffers injury that results in permanent disability.
• The Owner -Builder did not have a; Homeowner's insurance. policy on the house against which to submit
a claim.
■ The Owner-Builder.is now a defendant in a lawsuit for reimbursement for benefits paid to the injured
worker.
Did you know - unlicensed persons.frequently..have the property. owner obtain an "Owner -Builder" building
permit which erroneously implies., that -the property owner is.providing-his or herown labor and. material
personally?
Did you know -your homeowner's insurance may .not -provide coverage for injuries sustained on your
property by an unlicensed contractor and.his/her employees?
Did you know - if you, are considered -an "employer" understate and federal law, you must register with
the state and; federal government; withhold payroll taxes, provide_ workers compensation and disability
insurance and contribute to"unemployment compensation for 4ach'"employee"?
Did you know - that if you fail to abide by these laws you may be subjected to serious financial risk? .
OWNERS BEWARE AND CONSIDER'THE RISK BEFORE'AC,CEPTING FULL RESPONSIBILITY FOR
YOUR CONSTRUCTION PERMIT .
P:O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINT A, CALIFORNIA 92253
BUILDING .& SAFETY DEPARTMENT
(760)777-7012
FAX (760) 777-7011
PROPERW OWNERS PACKAGE
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a buildin permit. has been submitted in :.your name Ii ti g yoursel as the builder of the property
improvements specified at / io(o w�- / n ( �� L� UUlAfn}
We are providing you with anOwner-Builder. Acloiowledginent and Information Verification Form to make you aware of your
responsibilities and possible risk you may incur-byhaving 'this'permit issued in your name as the
Owner -Builder. We will not issue a building -permit untif.you:have read; initialed your understanding
:of each provision,
signed, and returned this form to us at our official. address•. indicated. An.agent of -the owner cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting:authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION `
DIRECTIONS: Read and initial each statement below. to si i you. understand or verify t is information.
1. I understand a frequent practice of unlicensed persons is to have the property .owner obtain an "Owner -Builder"
buil ' g permit that erroneously implies.that the property owner.is providing his or her own'labor and; material personally. I, as
an Owner -Builder, may held liable'and'subject to serious financial risk for any injuries sustained;'by an unlicensed person
and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
on my property.
d._2. I understand building permits are not required to be signed by. property owners unless they are responsible for the
construction and are nothiring a licensed Contractor to assume this responsibility.
fn 3. I understand as an "Owner -Builder". I am the responsible party of record on the permit. I understand that I may protect
myself from potential. financial risk by hiring a licensed Contractor and having thepermit filed in his or her name instead of my
own.
4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
perrrnts and contracts.
�5. I understand if I employ or otherwise engage anypersons, other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law. "
6. I understand if I am considered an `.`employer" under state and federal law,.I must register with the state and federal
government, withhold payroll taxes, provide. workers' compensation disability insurance; .and' contribute to unemployment
compensation for each "employee." I also understand my failure to abide by these, laws may •subject me to.serious financial
risk.
i7. I understand under California Contractors',State License Law an Owner -Builder wh
o builds smgle.-
farmly residential
structures cannot legally build them with the intent to offer 'them. for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
8. I understand as an Owner -Builder, if I sell theproperty for which :this permit is .issued, I may be held liable for any
financial or personal injuries 'sustained' by any: subsequent owner(s) •that result from any latent construction defects in the.
workmanship or materials.
b9.'
I understand I may obtain.more-information regarding my obligations as an "employer" from the Internal Revenue
Service, the United States Small .Business Adririnistration, 'thb California -Department of Benefit Payments, and `the California
Division of Industrial Accidents. I. also understand I may contact the California Contractors' State License Board (CSLB) at 1-
800-321-CSLB (2752) or www.csIb.ca.gov.f6r more information abouf•licensed, contractors.
krty10. I am aware of and consent to an Owner -Builder buildingpermit.applied for.in my name, and understand that I am the
legally : and financially responsible for proposed construction activity at the following address:
111. I agree that, as the party legally and financially responsible for. this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner -Builders as.welLas employers.
12. I agree to. notify the issuer of: this<form.immediately of any additions,; deletions, or changes to any of the information I
ha a provided on this form Licensed: contractors. are regulated by laws designed,to protect the public. If you contract with
someone who does not have a license', the Contractors' State License Board may be unable to assist you with any financial loss
you may sustain as a result of a complaint. Your only remedy against -unlicensed Contractois may be in civil court. It is also
important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working
on your property, you maybe held liable for damage's. Ifyou obtain a>permit as Owner -Builder and. wish to hire Contractors,
you will, be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation -insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issuing the permit. Note. A copy of the propen)vowner's driver•''s license, form notarization, or
other verification acceptable. to the.agency.is required, to be -presented when the permit is issued to verify the property
owner's signature.
Signature of property ovT 1 Date:
Note.. The following Authorization. Form is required to, be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
Excluding the Notice to PropertyOwner; the execution of which I understand is my, personal -responsibility, I hereby authorize
the following person(s) to act as my agent(s)'to,apply for, sign; and file the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury. that I am the property owner for the�address listed above and I personally filled out the above
information and certify its accuracy..Note: A copyof the.owner's-driver's license, form.notarLzation; or other ver fcation
acceptable to the agency is required to be presented when the permit is issued to verify the property owners signature.
Property Owner's Signature: Date:
6
A_ ✓
Bin
Qty. of -4 Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
a4,2 La',Quinta, CA 92253 - (760):;77-7012
Building Permit Application. and Tracking Sheet
Per it
Project Address:
Owner's'Name: �(�(> op`C
A. P. Number:
Address:
Legal Description:
,City, ST, Zip:r f,9.713
ontra
C ctor. GE VT
r
T ele
hone: b 3 3 99
Address: / � a,s EAS'- V [.::k&A(A Owe-
Project Description: �,fsl%q L C, 1/Z
aa�a
City, ST, Zip: PA -i-10 S���ys C� 90
Telephone: �,/� 35 Sg
0 W
:
T
TO
State Lic. # : C I `14! a 3 �
City Lic.:#
J /nil . 5 /f
Arch., Engr., Designer:
Address:
City., ST, Zip:
t•
Te le hone:
>
. Co'n structi n Type: Occupancy:
cY:
State L ic. #
'ProJect ty e' cir la ne • New Add'n Alter Repair' Demo
Name of Contact Person:
Sq: Ft'.
#Stories:
#Units:
Telephone # of Contact Person:
'Estimated Value of Project:.
APPLICANT::DO>NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rec'd
TRACKING
PERMIT -FEES
Plan Sets
Plan Check submitted
It
Amount
Structural Calcs.
Reviewed, ready for -corrections
Plan Check•Deposit
Truss Cates.
: Called Contact Person
Plan Check'Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
tae Review; ready for:corrections/issue
Electrical
Subcontactor List
Cal led, Contact: Person
Plumbing
Grant Deed
2PIans picked up
S.M.I.
!
H.O.A. Approval
.'.Plans
resubmitted.
Grading
IN HOUSE:-
7rd Review, ready for. correctionsrissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P:P.
Pub. Wks. Appr
Date of per'Wf issue
School Fees
Total Permit Fees