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BRER2017-0007
Applicant: Contractor: ROBERTTO GASCON. OWNER BUILDER 54370 AVENIDA OBREGON LA QUINTA, CA 92253 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 Professions Code, and my License is in full force and effect. License Class: License No.: Date: Contractors 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 comp nsation, 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.). RS)'-I, as owner of the property, am exclusively contracting with licensed contractors instruct 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.). 1116bTarn exempt under Sec. B.&P.C. for this reason Date:- 3® owne�(9 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: LIC. 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 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:_ Policy Number: _ W• - -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 3700 of the Labor Code, I shall forthwith comply with those provisions. > / Date: Z/36117 Applica- nt: / ?l�4j/ _,! 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 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 upon the above-mentioned property for inspection purposes. Date:'/ � 7 Signature (Applicant or Ageni ~ 78-495 CALLE TAMPICO V VOICE (760) 777-7125 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 1/30/2017 Application Number: BRER2017-0007 Owner: Property Address: 54370 AVENIDA OBREGON CARMEN GASCON APN: 774242005 5971 MEADOWLARK DR Application Description: GASCON / REROOF HUNTINGTON BEACH, CA 92253 Property Zoning: Application Valuation: '$2,500.00 Applicant: Contractor: ROBERTTO GASCON. OWNER BUILDER 54370 AVENIDA OBREGON LA QUINTA, CA 92253 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 Professions Code, and my License is in full force and effect. License Class: License No.: Date: Contractors 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 comp nsation, 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.). RS)'-I, as owner of the property, am exclusively contracting with licensed contractors instruct 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.). 1116bTarn exempt under Sec. B.&P.C. for this reason Date:- 3® owne�(9 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: LIC. 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 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:_ Policy Number: _ W• - -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 3700 of the Labor Code, I shall forthwith comply with those provisions. > / Date: Z/36117 Applica- nt: / ?l�4j/ _,! 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 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 upon the above-mentioned property for inspection purposes. Date:'/ � 7 Signature (Applicant or Ageni ~ Date: 1/30/2017 Application Number: BRER2017-0007. Owner: Property Address: 54370 AVENIDA OBREGON CARMEN GASCON APN: 774242005 5971 MEADOWLARK DR Application Description: GASCON / REROOF HUNTINGTON BEACH, CA.92253 Property Zoning: Application Valuation: $2,500.00 Applicant: Contractor: ROBER170 GASCON OWNER BUILDER 54370AVENIDA OBREGON LA QUINTA, CA 92253 LIc. No.: Detail: REROOF WITH OWENS CORNING SUPREME AMBER SHINGLE [CRRC: 0890-0014] 2013 CALIFORNIA ENERGY CODE. c DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT RE -ROOF - FIRST 2,000 SF 101-0000-42404 0 $51.68 DESCRIPTION ACCOUNT QTY AMOUNT RE -ROOF - FIRST 2,000 SF PC 101-0000-42600 0 $103.36 Total Paid for RE -ROOF: $155.04 9 Bin ## . Permit # t j DAddress: 70 Clay of La Q U«n to Building U Safety Division 78-495 Calle. Tampico La Quinta, CA 92253 - (760) 777-701,2 Building Permit Application and Tracking Sheet Ale O re o/.-� i Lo o Pr C a.9 06 A. P. Number: � a*ss: 70 191e"01. Legal Description: Contractor: t CST, Zip:4 P: 4 ey 14 cap. T elehn: oc P S S 6 S �l S Address: AIME P.rpject.Description: - City, ST, Zip: -769 Cf t"% . e /rP roo/' TeleP hone: State Lic. # : City Lie. #•: Arch., Engr., Designer: Address: City, ST, Zip: Telephone. one: Construction n TYPe: Occupancy: : t a Sto Lic. #• ' Project type (circle one)., New Add'n Alter Repair. Demo o I Name-of Contact Person: ®'�7- C Q1S,C0' ( T�6one # of Contact Person: 760-8,1(9 fS OS mV)Estimated S�t- �j ��� # Stories: # Units: Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE tl Submittal Req'd Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item- Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical . SubcontactorList Called ContactPcrson Plumbing Grant Deed Plans picked up S.M.I. Ii.O.A. Approval Plans resubmitted Grading IN ROUSE:- 3"! Review, ready for correctionsrssue Developer Impact Fee Planning Approval Called Contact Persoh Pub. Wks. Appr Date of permit issue School Fees, Total Pcrmit Fees W� STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CEC-CFIR-ALT-01-E Revised 06/14) CERTIFICATE OF COMPLIANCE Prescriptive Residential Alterations Proiect Name: CALIFORNIA ENERGY COMMISSION CFIR-ALT-01-E (Page 1 of 4) Date Prepared: A. GENERAL INFORMATION 01 02 N 01 Project Name: 3 0 N'i 02 Date Prepared: 03 Project Location: L/— 37 0— r/ Y 06reacm 04 Building Front Orientation (deg or cardinal): 05 CA City: CA 0 v IH cf C dy 06 Number of Altered,Dwelling Units: " :\ 07 Zip Code: z z S 08 Fuel Type: 4 09 Climate Zone: ^Initial Solar 10 Total Conditioned Floor -Area (ft2)>3 11 Building Type 12 Slab,Area (ft2) 13 Project Scope: Pitch Exception V, y B. BUILDING INSULATION DETAILS (Section 150.2(b)1) 01 02 03 04 05 06 ,--; ` , '07 1 08,'-'J1 X09 10 11 Tag ID I Assembly Type Frame I Type Frame Depth (inches) Frame Spacing (inches) Proposed ����"��'A Required Comments Cavity R -value .l,Continuous Insulation R -value , 4l5pendix JA4 Reference Ofictor Table. Cell U -Factor R -value C: Propos d Minimum Required ^Initial Solar Aged Solar Thermal SRI Aged Solar Thermal SRI Method of Roof C CPRroduct ID ro ��` Deck.y Compliance Pitch Exception V, y �-� ✓ PfOdIICt Type Insulat/i�on C. ROOF REPLACEMENT (Prescriptive Alteration, Se6fio6ry15'0.2(b)1H) 01 02 03 0405`L 06 �i' '07�-i 08 09 10 11 12 13 R -value C: Propos d Minimum Required ^Initial Solar Aged Solar Thermal SRI Aged Solar Thermal SRI Method of Roof C CPRroduct ID ro ��` Deck.y Compliance Pitch Exception <., s , Nqqumber �-� ✓ PfOdIICt Type Insulat/i�on Reflectance Reflectance Emittance (Optional) Refle�cttaance Emittance _ (Optional) NOTES • Roof area covered by; building integrated photovoltaicpanels and solar thermal panels are exempt from the above Cool Roof requir • Liquid field applied�oati-ngs must comply with installation criteria from section 110.8(i)4. Ag--R�ELLVCI I V -N€110 V-1 jo AiIC) Registration Number: Registration Date/Time: HERS Provider: CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014 STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS La L:-G1.1K-AL1-U1-E Revised obna CALIFORNIA ENERGY COMMISSION N4,Z!,A CERTIFICATE OF COMPLIANCE . CF1R-ALT-011E Prescriptive Residential Alterations (Pace 4 of 4) Project Name: I I Date Prepared: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate ofjCompliance documentation is accurate and complete.„ Documentation Author Name: i Documentation Author Company:. i Signature Date: Address:I f" �/ 3 70 l��:e a r� C^ CEA/ HERS Certification Ideaificafion-(if applicable):_ (- rt� i. City/State/Zip :I'a I/�h�4 ; C0( 2 Phone: - RESPONSIBLE PERSON'S DECLARATION STATEMENTV�' `� I certify the following under penalty of perjury, under the laws of the State of California: 1. The information provided on this Certificate of Compliance is true and correct. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsib; I ty�forthe building de gn or system design identified on this Certificate of Compliance (responsible designer).° 3. That the energy features and performance specifications, materials, compon6iitts, and`manufacture'd device for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of'Reg�ilations. 4. The building design features or system design features identified on thisCertificate of Co mpliance are consisten itthtltl a information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the'enforcement agency for=approval with this building permit application. 5. 1 will ensure that a registered copy of this Certificate of Compllan,ceshall be made�a�v�allable with the building permit(s) issued for the building, and made available to the enforcement agency for I copy ed all applicable inspections. understand that a registered of this Certificate -of Compliance is.requi to be included with the documentation the builder provides to the building owner at occupancy. .., o" Responsible Designer Name: iResponsible Designer Signature: i�, tC Company :tP ` l+ firs " 7Y Date Signed: r a l� e 1eA .4Y Address: � � 5`�, License: . rr City/State/Zip: 3;'•' Phone: `V For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300. Registration Number: Registration Date/Time: CA Building Energy Efficiency Standards - 2013 Residential Compliance HERS Provider: June 2014 BUILDING & SAFETY bEPARTMENT 78-495 CALLE TAMPICo (760) 777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 Considering Becoming an Owner -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 Owner -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. Benefit/Risk: 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 construction management, knowledge, workmanship, and completion of the job. You benefit by not paying others to perform 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-contiactors to perform portions of the construction work. WARNING: The benefit of protection provided by law when you hire only California licensed sub -contractors can tum to serious financial .risk if you hire unlicensed contractors to perform any of the work Benefit/Risk: Possible Benefit and Significant Financial Risk Owner -as -Employer is a type of.Owner-Builder where you pay any unlicensed individual to perform any construction work valued at more than 5500.00, 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 benefit can turn'to serious financial risk if you fail to deduct payroll taxes or provide workers compensation insurance for each worker. Benefit/Riski Possible. Benefit with Significant Financial Risk (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 - Liability 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 suffer financial harm due to defective workmanship and injured employees. Following are alarming examples of what has occurred with Owner -Builder permits: Example 1: Homeowner received insurance money to rebuild burned -down home. ■ Owner/Builder permit pulled to rebuild structure. ■ Unlicensed contractor built substandard structure — must be torn down and replaced. • Estimated financial injury is $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 had active license but fled an exemption from Workers Comp. • Owner -Builder hires brother-in-law to install a new roof. ■ .Employee falls and sustains multiple spinal and extremity fractures as well as a head injury and remains in a 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 her own 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" under state 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 each "employee"? Did you know —that if you fail to abide by these laws you maybe subjected to serious financial risk?. OWNERS BEWARE AND CONSIDER THE RISK BEFORE ACCEPTING FULL RESPONSIBILITY FOR YOUR CONSTRUCTION PERMIT P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING &G SAFETY DEPARTMENT - PROPERTY OWNER'S PACKAGE (760)777 -7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application -for a building t has been submitted in your name listing yourself as� the builder of the property improvements -specified at -' © le We are providing you with an Owner -Builder Acknowledgment a nfoimation Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building permit until 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 signs you understand or verify this information. 1. I understand'a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneous) lies that the roe )der Y implies property rty owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be 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. 961 2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. _3. I understand as an"Owner-Builder" J 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 the permit filed in his or her name instead of my own. PC, 4. I understand Contractors are required bylaw to be licensed and bonded in California and to list their licen permits and contracts. se numbers on L7 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at -least five hundred 'dollars ($500), including labor and materials, I shay be considered an "employer" under state and federal law. I?n 6. 1 understand if:I am considered.an "employer" understate 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. 7. 1 understand under California Contractors' State License Law, an Owner -Builder who builds sin le-famil resid g y entral 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 the property 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. 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the 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.cslb.ca.gov for more information about licensed contractors. 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally: and financially responsible for proposed construction activity at the following address: 11. 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 asmell as employers. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have 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 Contractors 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 may be held liable for damages. If you 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 property owner'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 owner 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. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, 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 Perinif 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 copy of the.owner'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 owners signature. Property Owner's Signature: Date: