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BRER2016-0071Applicant: JORGESANTOS 51735 AVENIDA RAMIREZ 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:140528101254135508 Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that [a' rri 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 f) I, as owner of the property, or my employeeswith 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 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 SAh o she did not build or improve for the purpose of sale.). . I a s 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 O.ontractors' State License Law.). I am exempt under Sec. B.&P.C. for this reason CDate_ O 14 Owned/ ii 4,e Ss CA 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 Contractor: JORGESANTOS S17 3S AVENIDA RAMIREZ LA QUINTA, CA 92253 (760)219=6268 Llc. No.::CONV:140528101254135508 ..WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations I have and will maintaiWa 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, focthe performance of the work for which this permit is issued -My workers' compensation insurance carrier and policy number are: Carrier: Policy Number: 'NI certify that in the performance of the work for which this permit is issued, I shalln to 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 /4 a bd r _ 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 personuponwhose" 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 shalfdefend, indemnify and hold harmless the City of La Quintalits4cers, agents, and employees for any actor 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 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. DSignature (Applicant or Agent) l S 49,� VOICE (760) 777-7125 78-495 CALLE TAMPICO FAX (760) 777-7011 FAX LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT. DEPARTMENT (760) 777-7153 BUILDING PERMIT. Date: 7/5/2016 Application Number: BRER2016-0071. Owner: Property Address: 51735 AVENIDA RAMIREZ. JORGESANTOS. APN: 773125023 5173SAVENIDA RAMIREZ Application Description: SANTOS /.INSTALL NEW UNDERLAYMENT AND RESET CLAY TILE LA QUINTA, CA 92253 Property Zoning: Application Valuation: $1,000.00 Applicant: JORGESANTOS 51735 AVENIDA RAMIREZ 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:140528101254135508 Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that [a' rri 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 f) I, as owner of the property, or my employeeswith 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 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 SAh o she did not build or improve for the purpose of sale.). . I a s 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 O.ontractors' State License Law.). I am exempt under Sec. B.&P.C. for this reason CDate_ O 14 Owned/ ii 4,e Ss CA 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 Contractor: JORGESANTOS S17 3S AVENIDA RAMIREZ LA QUINTA, CA 92253 (760)219=6268 Llc. No.::CONV:140528101254135508 ..WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations I have and will maintaiWa 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, focthe performance of the work for which this permit is issued -My workers' compensation insurance carrier and policy number are: Carrier: Policy Number: 'NI certify that in the performance of the work for which this permit is issued, I shalln to 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 /4 a bd r _ 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 personuponwhose" 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 shalfdefend, indemnify and hold harmless the City of La Quintalits4cers, agents, and employees for any actor 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 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. DSignature (Applicant or Agent) l S Description: SANTOS / INSTALL NEW UNDERLAYMENT AND RESET CLAY TILE Type: RE -ROOF Subtype: Status: APPROVED Applied: 7/5/2016 SKH Approved: 7/5/2016 SKH Parcel No: 773125023 Site Address: 51735 AVENIDA RAMIREZ LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 55 Lot: 11 Issued: UNIT 5 Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $1,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 CONTACTS 'ADDRESSl CITY Details: INSTALL NEW UNDERLAYMENT AND REPSET CLAY TILE. 2013 CALIFORNIA ENERGY CODE. FINANCIAL INFORMATION Printed: Tuesday, July 05, 2016.10:18:57 AM 1 of 2 sysrrnns CONDITIONS PHONE'' $':` FAX Y REMAIL CONTACTS 'ADDRESSl CITY STATE ZIP , '`: APPLICANT JORGE SANTOS 51735 AVENIDA RAMIREZ LA QUINTA CA 92253 (760)219-6268 CONTRACTOR JORGE SANTOS 51735 AVENIDA RAMIREZ LA QUINTA CA 92253 (760)219-6268 OWNER JORGE SANTOS 51735 AVENIDA RAMIREZ LA QUINTA CA 92253 (760)219-6268 FINANCIAL INFORMATION Printed: Tuesday, July 05, 2016.10:18:57 AM 1 of 2 sysrrnns DESCRIPTION ACCOUNT CITY AMOUNT PAID ' PAID DATE RECEIPT.# .CHECK .'METHOD; PAID CLT D r BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 7/5/16 R16779 DEBIT JORGE SANTOS SKH Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: RE -ROOF -FIRST 2,000 101-0000-42404 0 $49.31 $49.31 7/5/16 R16779 DEBIT JORGE SANTOS SKH SF RE -ROOF - FIRST 2,000 101-0000-42600 0 $98.62 $98.62 7/5/16 R16779 DEBIT JORGE SANTOS SKH SF PC Total Paid for RE -ROOF: $147.93 $147.93 TOTALS:4:$148.93 INSPECTIONS PARENT PROJECTS -- ATTACHMENTS Printed: Tuesday, July 05, 2016 10:18:57 AM 2 of 2 SYS TF. iviS 78-495-CALLE TA'MP.ICO LA QUINTA, CALIFORNIA 92253 N BuJLD1NG & SAFETY DEPARTMENT (760) 777-7012 FAX (760) 777-7011 Considering Beeomirig pan 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 personallyresponsible for. the construction and.you-are'not an Owner -Builder. Instead, you become a "Customer" and :California law provides you' benefit of protection from poor workmanship,�.failure to•finish the job and financial risk due to worker injury. Benefuwsk: 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 onyour own ability`to complete the job successfully. Benefit/Risk:- Possible Benefit'with Lon Financial Risk. Owner=as-Contractor is a type of Owner. -Builder where you.personally.act as, your own;GeneralContractor, the permit is taken out in your name and you hire California'licensed sub -contractors toper ; form, portions of the. construction work. WARNING: The benefit of protection provided by law when you.'hire'`oiily Californialicensed sub -contractors can turn to serious financial risk if you hire unlicensed contractors to perform anyofthe :work; Benefit%Risk: Possible Benefit and SiQnificaftfFinancial 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 be can turn *to serious financial risk if you fail to deduct payroll taxes or provide workerscompensation insurance for each worker. Benefit/Msk: Possible Benefit .with "Sienifcant 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 ahead 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 4 . 4. P;'0.. Box 1504. LA QIiINTA, CALIFORNIA '92247-1504 78-495-CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 . . I BUILDING & SAFETY DEPARTMENT - PROPERTY :PACKAGE (760).'777-7012 FAX (760) 777-7011 Disclosures & Forms.10r; Owner -,Builders Applying for Construction Permits IMPORTANT! NOTICE TO -PROPERTY -OWNER Dear Property,Owner: An application''for a, building- pehnit has been 'submitted in your name listing yourself as the builder of the property iniprovements,specificd'it 5X7.,?, 5. - We are providing you with an Owner -.Builder `Acknowledgment and, Information Verification' Form' to.make , you aware.of your responsibilities and,possible nsk'yo,u maytmcur by in your name a . s - the not building'� initialed your understanding of each provision, Owner -Builder. -We will rer, t f _4 this form to us at our OW - u 'd An signed, and. returned agent nt Of the ,owner cannot execute this notice unless you, the property owner, obtain the prior approvAl.of the permitting authority.. DIRECTIONS: Read'and initial each statement &16W signify ' —to ��gnfyyouunderstand orvertfy,ihisinfo7nration'. 1. 1 understand a frequent practice of unlicensed persons is to have. the property roperty owner obtain an "Owner -Builder" 'building permit that erroneously implies that the propertylowner is providing his or her own labor and material personally. 1, as an Owner -Builder, may -be heldiliable and subje*ct'td seriousfinin'cia,frisk for any injuries ' es 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. )_42- I understand building permits are not required to be iigned' by. property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assumethisresponsibility.- jd' 3. 1 understand as an "Owner -Builder I. am the iespoii4ft lc'oarty of the -permit. I understand that I may protect "myself from . in potential. financial risk kby . hiring a licensed .*Cont , ractor:and having the peirmit filed:in his 'or her name instead of my OVM. a4. I understand Contractors are required by law to. be licensed and bonded in California and to list their license numbers on permits and contracts. A5. 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 dol.lars (000), 'including labor.and materials, I may bedonsidered an "employer" under state and federal law. A6.ml underst and if I am consideredan "ehip]oyer" under state and federal lawi-I must register with the state and federal rn ent, withhold. payroll taxes, provide workers cornpens . Atioh disabilityins' cc 'd contribute to unemployment urap , an compensation for each "employee." I -also understand my failure to abide by these laws may subject me to.scrious financial risk. #/=I understand under Califom�'ia,Contractors' *Stite.�License Law, an Owner -Builder who builds single-family residential res cannot legally 0 build them with the intent to *offer them- for saI6; unless all work is performed by licensed subcontractors and the number of structures does not:exceed four within anycc 'al'nda'r 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,d 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 anOwner-Builder building permit applied for in my name, and understand that I am the party legally, and Jftrnancially ,responsible for proposed constru�on activity at the following address: 1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all a pp licable laws and requirements q 1S that govern Owner -Builders as.well as employers. 12.1 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 �i , l s 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 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 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 vert the property owners signature. Property Owner's Signature:'—. r�'S t' d-7 c5 Date: 171A y f i• N Bin # City of La Quinta Building ST Safety Division 78-495 Calle Tampico La Quints, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # ,P ect Address:.. ��/ r, A4�, �� lO ne�Name: r 5� A. P. Number: < ZWBd�s: 51,7 AVe 4t7 ?/ Legal Description: t6ity, ST, Zip: Contractor.s T h n ele o e. _P 60 2 /16'z Address:» Protect Description: 12 City, ST, Zip: Telephone: ele hone: State Lie. # : City, Lie. #•: Arch., Engr., Designer: Address: City., ST, Zip: Telephone: _ Construction Type: Occupancy: State Lic. #: ProJec ttYPe (circle.one): New Add'n Alter Repair' Demo I ... c "Namef Contact Person: Sq. Ft.: #.Stories: #Units: =Telephone # of Contact Person:.. Esq tim ed Value of Project: (— - APPLICANT::DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan. -Check submitted Item Amount Structural Calcs. Reviewed, readyfor corrections Plan Check Deposit Truss Cales. 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 Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up H.O.A. Approval Plans resubmitted Grading IN ROUSE:- ".`d. 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