Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
BRER2016-0009
78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 c&t!t 4 4 Q�m&, COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BRER2016-0009 Property Address: 54100 EISENHOWER DR APN: 774221005 Application Description: 54100 EISENHOWER DRIVE; REROOF Property Zoning: Application Valuation: $5,000.00 Applicant: REBECCA MORENO 54100 EISENHOWER DRIVE 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.::CONV:140528101253032886 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 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 ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure isnot 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 am exempt under Sec. , B.&P.C. for this reason /-N Date: ' (V 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 60 VOICE (760).777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 2/1/2016 Owner: REBECCA MORENO 54100 EISENHOWER DRIVE LA QUINTA, CA 92253 Contractor: REBECCA MORENO 54100 EISENHOWER DRIVE LA QUINTA, CA 92253 (760)574-0385 Llc. No.::CONV:140528101253032886 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: 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 comply with those provisions. Date: 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 ($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 tfriSity to enter uponhe above-mentioned property for inspection purposes. 1 ) n Date: 60 Signature (Applicant or Agent) DESCRIPTION FINANCIAL • ACCOUNT : J . • QTY ., AMOUNT. PAID PAID DATE. BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 PAID BY METHOD RECEIPT# CHECK # CLTD BY Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00 DESCRIPTION. ACCOUNT QTY:; AMOUNT PAID PAID DATE RE -ROOF - FIRST 2,000 SF 101-0000-42404 0 $49.31 $0.00 PAID BY METHOD RECEIPT.# CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RE -ROOF - FIRST 2,000 SF 101-0000-42404 0 $49.31 $0.00 PAID BY METHOD RECEIPT # ` •CHECK # CLTD BY, DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RE -ROOF - FIRST 2,000 SF PC 101-0000-42600 0 $98.62 $0.00 PAID BY METHOD. -RECEIPT # CHECK # CLTD BY Total Paid for RE -ROOF: • $197.24 $0.00 •• T. Permit Details PERMIT NUMBER City of La Quinfa BRER2016=0009:v Description: 54100 EISENHOWER DRIVE; REROOF CONDITIONS Type: RE -ROOF Subtype: Status: UNDER REVIEW Applied: 2/1/2016 MFA Approved: Parcel No: 774221005 Site Address: 54100 EISENHOWER DR LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA AT VALE LA QUINTA Block: 297 Lot: 20 Issued: UNIT 27 NAME ADDRESSI CITY Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $5,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 CA Details: REROOF WITH SHINGLES [CRRC: 0890-0009) (760)574-0385 2013 CALIFORNIA ENERGY CODE. CHRONOLOGY CONDITIONS CONTACTS NAME TYPE- NAME ADDRESSI CITY STATE ZIP PHONE FAX . EMAIL APPLICANT REBECCA MORENO 54100 EISENHOWER LA QUINTA CA 92253 (760)574-0385 DRIVE CONTRACTOR REBECCA MORENO 54100 EISENHOWER LA QUINTA CA 92253 (760)574=0385 DRIVE OWNER REBECCA MORENO 54100 EISENHOWER LA QUINTA CA 92253 (760)574-0385 ' DRIVE FINANCIAL INFORMATION Printed: Monday, February 01, 2016 1:38:00 PM 1 of 2 11717 SYSTEMS INSPECTION$ PARENT PROJECTS Printed: Monday, February 01, 2.016 1:38:00 PM 2 of 2 SYSTEMS '# CL DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK METHOD PAID BY Y BY BSAS SB1473 FEE 1 101-0000-20306 0 $1.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: RE -ROOF - FIRST 24000 101-0000-42404 0 $49.31 $0.00 SF RE -ROOF.- FIRST 2,000 301-0000-42404 0 $49.31 $0.00 SF RE -ROOF - FIRST 2,000 101-0000-42600 0 $98.62 $0.00 SF PC Total Paid for RE -ROOF: $197.24 $0.00 TOTALS: $198.24 00 INSPECTION$ PARENT PROJECTS Printed: Monday, February 01, 2.016 1:38:00 PM 2 of 2 SYSTEMS Bin # CCO9 City of La Q Uin to Building a Safety Division . . 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # JSEjEIZ2-0I (vt Project Address: Owner's Name:' (� . A. P. Number: Address: �5� Legal Description: City, ST, Zip: v1 �0110 Contractor: Tele hone: — —d P 4 1 5� 3 Address:�l Project Description: _ City, ST, Zip: U nnnn l.�� Jakut oo CGl'Vl Te e hone: IP State Lic. # : City Lic. #.- ;Arch., Arch.,Engr., Designer: Address: " City, ST, Zip: Telephone: an cY: n tructi n e: Occupancy: CoT s o Y P P State Lic. # ProJ'ect type circle one): w A dd'n Alter Repairair Demo Name of Contact Person:Sq. Ft.: I #Stories: ( # Units: Telephone # of Contact Person: I Estimated Value of Project: VS oo APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd 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 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees, Total Permit Fees El STATE OF CALIFORNIA TIONS CEC-CFIR7ALT=01-E Revised -06/14` CALIFORNIA ENERGY COMMISSION 'tiLc� CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E Prescriptive Residential Alterations (Page 4 of 4) Project Name: Date Prepared: -DOCLINIENTATION AUTHOR'S DECLARATION STATEMENT I certify that this Certificate of Compliance documentation is accurate and complete. Documentation Author Name: l ume tion Author Signature: Company: Signature Date: A; LL Address: S (W _i4_,- CEA/ HERS Certification Identlficatb&(if pplicable): E c)nb0A,4)42r or City/State/Zip: L, �u� 3 Phone:- i �y o� N_ 03 =RESPONSIBLE PERSON'S DECLARATION STATEMENT 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. 'Ity 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsib for the building'deessign or system design identified on this Certificate of Compliance (responsible designer). 3. That the energy features and performance specifications, materials, componentstand manufacture'ddpvi�ces, for the building design or system design identified on this Certificate of - ofJifk'4 California Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the Code of`Regulations. ' are 4. The building design features or system design features identified on thisCertificate of Complianc consistentt-With?he information provided on other applicable compliance documents, rrfok bi worksheets, calculations, plans and specifications submitted the"erircement agencyfor approval with this building permit application. W ble with p 5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made,avatiii permit(s) issued for the building, and made available to the enforcement agency the building for all applicable inspections. I understand that a registered t opyof thisertificateL 51 Compliancy e`qulred'to be included with the documentation the builder provides to the building owner at occupancy.% Responsible Designer Name: f Responsible Designer Signature: @fig Company: �° l`} �"�j "y �j Date Signed: � # � Address: V License: City/State/Zip: �""''�� `�`"'' Phone: NSA For assistance or -questions regarding the Energy Standards, contact the Energy Hotline at:. 1-800-772-3300. Registration Number: Registration Date/Time: HERS Provider: CA Building Energy Efficiency Standards - 2013 Residential Compliance I I June 2014 STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CEC-CFIR-ALT-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION CGE.RTIFICATE-QF-(:QM P-LIAN-CE CF111-ALT-01-E Prescriptive Residential Alt ations (Page 1 of 4) . P_ro.i.ec Name:---=TDate�Rr-epar-ed:----o A'CGENERAL,INFORMATION 01 , 01 Project Name: 02 Date Prepared: 03 Project Location: 04 Building Front_OrieAtation'(deg or cardinal): 05 CA City: 06 Number of Altered,Dwelling Units: e 07 Zip Code: 08 Fuel Type: (� A� 09 Climate Zone: 10 Total,Coriditioned Floor Area '(ft2)1' 11 Building Type 12 S6b,Wre`a'(ft2) V 13 Project Scope: — i'"N) `- it .'%' 4\ 'J B. BUILDING INSULATION DETAILS (Section 150.2(b)1)� 01 02 03 04 05 06 .�;4 07 08t �' QS) 10 11 Tag/ID . Assembly Type Frame Type Frame Depth (inches) Frame Spacing (inches) 1�1Popo ed 'initial Solar Aged Solar Thermal SRI Aged Solar Thermal SRI Required Comments Continuous Cavity �dlnsulation R -value R -value #fi 1 P , U;factor .�.APPen 1A4 Reference LI -Factor Table. Cell Pitch Exception. ( Number t,,P,rodact Type _' e Insu on Reflectance _ Reflectance Emittance (Optional) Reflectance Emittance (Optional) IU car Ig `,,ANN a o Ir -%\'V YF )L IV -h \vN rC. ROOF REPLACEMENT (Prescriptive Alteration, Section 150.2(b)1H INT 01 02 03 04 4:t� 0 06 +r'0,7;�K 08 09 10 11 12 13 + R -value 1l Proposed Minimum Required 'initial Solar Aged Solar Thermal SRI Aged Solar Thermal SRI Method of Roof CRRC�P�d D .�. y Deck,, Compliance Pitch Exception. ( Number t,,P,rodact Type _' e Insu on Reflectance _ Reflectance Emittance (Optional) Reflectance Emittance (Optional) IU car Ig `,,ANN a NOTES` , • Roof'area covered by, building., integrated photovoltaid-panels and solar thermal panels are exempt from the above Cool Roof requirements. • Liquid field applied coatings must comply with,installation criteria from section 110.8(1)4. Registration Number: CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: HERS Provider: June 2014 Note: Aged solar reflectance and thermal emittance values noted in tables below must be derived from CRRC Rated Products Directory at http://www.coolroofs.org/products/search.php. Being included in the EPA's ENERGY STAR® list for cool roofing materials is NOT sufficient to meet the Standards. If a roofing product is not CRRC certified, it is assumed to have the following default aged reflectance/emittance values: for asphalt shingles: 0.08/0.75; for all other roofing products, 0.10/0.75. The following information applies to conditioned (mechanically cooled or heated) residential buildings demonstrating compliance using the Prescriptive approach. Requirements ClimaterSolar 3-yr Aged Min. Thermal Roof Style Zone Reflectance Emittance Min. SRI j Low-slo e A 13 & 15 0.63 0.75 75 et/rAteep-slope" 10 thru 15 0.20^^ 0.75 16 JExcer)tions... Cool roof is 08T required if: Documentation + Permit + Any slope The roof area is covered by building -integrated photovoltaic + panels or building -integrated solar thermal panels CF1R-ALT-01-Ec: Certificate of Compliance — Residential Alterations o General information (Part A; of Pagel of 4) Roofing Replacement (Part C, Page 1 of 4) ¢ Declaration Statement (Page 4 of 4) Submitted to the building department by the contractor or the home owner. (Optional).CF1R-ENV-04-E: Certificate of Compliance— Solar Reflectance Index Calculation Worksheet Any slope Building has no ducts in the attic + MR -ENV -04-E: Installation Certificate for Envelope — Any slope Roof is ori addition x300 ft2 . Insulation; Roofing; Fenestration 0.54-0.50 6 d Description of Roofing Products (top half of Page 1. of 2) Any slope Roof construction has a thermal mass over the roof o Declaration Statement (Page 2 of 2) membrane with a weight of at least 25 Ib/ft2.B The CF2R-ENV-04-E must be completed and signed by the Steep slope. An air -space of 1.0 inch is provided between top of roof installing contractor and made available for final inspection by deck and bottom of roofing product. building department. CRRC label(s), described below, should Steep slope Existing ducts in the attic are insulated and sealed be attached to the CF2R-ENV-04-E form. according to §150.1(c)g. + Product Labeling: Steep slope Building has a radiant barrier in the attic meeting the o For all roofs: CRRC label specifying the initial and aged requirements of §150.1(c)2 ("weathered") solar reflectance and thermal emittance Steep slope Building has at ItIZ-8-ceiling insulation a For liquid -applied roof coatings applied to low -sloped roofs: Steep slope Roofing product profile ratio of rise to width is at least 1:5 • CRRC label specifying the initial and aged ("weathered") for >_50% of the width of the roofing product. solar reflectance and thermal emittance Steep slope R-0 or greater insulation above the roof deck in CZ 10-15 • Label stating the product meets the ASTM requirements specified in Section 110.8(i)4 of the Standards. Low slope The aged solar reflectance can be traded off with additional Product labeling must be available for final inspection by insulation added at the roof deck as per Table 150.2-A. building department. Values from Table 150.2-A Aged Solar Reflectance Roof Deck Insulation R -value 0.62-0.60 2 0.59-0.55 4 0.54-0.50 6 0.49-0.45 8 Aged Solar Reflectance Roof Deck Insulation R -value 0:44-0.40 12 0,39-0.35 16 0.34-0.30 20 0.29-0.25 24 Initial Weathered Solar Reflectance 0.00 Pending j)I�—Thermal Emittance 0.00 Pending CR C Rated ProdUCL 11D Number r'00I R, IKIF Licensed Seller ID Number Cla ssificirion Producaou Line j Cw,l Rco:` Rang C.-: it ra"z?a are detrnavned cert, sed art ..f wndfien:. and tnac ca Fr app ,p;iatr i f:. Qrarr.Inmaca srascet! %-; atm:! effect of A., ie`krcancr -6 he -I ra:ua.wre' r'n GJi:�n'c p'Rv:111]➢Cr IIIL': t'«: i ?Irur:ize�.rrr +r pndurl ;up:d::;za ;hm Mese ra—, 5 111le deeli-led r: aceerd>xe s:ilh i:e C.-! R -f Rain= C•caeni proc:lturs. A Low -slope = Rise to run ratio of 2:12 or less (9.5 degrees or fewer from horizontal). Steep -slope = Rise to run ratio greater than 2:12 (more than 9.5 degrees from horizontal). g This includes green roofs (roofs that are covered with vegetation) weighing at least 25 Ib/ftz, though any portion of the roof not covered with vegetation will need to comply with cool roof requirements if not otherwise exempt. ` Check with your local building department to determine if they have alternate documentation options. SDGj © 2013, 2014 Pacific Gas and Electric Company, San Diego Gas and Electric, Southern California Gas Company and Southern California Edison. All rights reserved, except that this document may be used, copied, and distributed without modification. Neither PG&E, Sempra, nor SCE — nor any of their employees makes any warranty, express of implied; or assumes any legal liability or responsibility for the accuracy, completeness or usefulness of any data, information, method, product, policy or process disclosed in this document; or represents that its use will not infringe any privately -owned rights including, but not limited to patents, trademarks or copyrights. 14 P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (760)777-7012 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. �nefitLRisk:—Iighest_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 -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 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 $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 benefit can tum to serious fmancial risk if you fail to deduct payroll taxes or provide workers compensation insurance for each worker. Benefit/Risk: Possible Benefit with Significant Financial Risk n (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 filed 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 may be subjected to serious financial risk? OWNERS BEWARE AND CONSIDER THE RISK BEFORE ACCEPTING FULL RESPONSIBILITY FOR YOUR CONSTRUCTION PERMIT Td4t °F XP Q" P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & 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 permit has been submitted in your name listing yourself as the builder of the property improvements specified at We are providing you with an Owner -Builder Acknowledgment and Information 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 signify you understand or verify this information. VAI. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder'.' building permit that erroneously implies that the property owner is providing his or her own labor and material personally.1, 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. QM -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" I am the responsible party of record on the permit. I understand that I may protect myself-from-potential-financial-rask by4ifting-a-licensed-Contractor-and-having-the-permit-frled-in-his-or-her-name-instead-ofmy own. P$A_4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on VIMand contracts. -" 1 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 may be considered an "employer" under state and federal law. Q�A_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. `Z 1 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family 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. PA -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. VM -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: RM 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 as well as employers. 944— 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 Contractorsmay 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 own Date: <0 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)xo-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: Tel No Address of Authorized Agent: 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 owner's signature. Property Owner's Signature: Date: