BPLB2016-0114Taff
'78-495 CALLE TAM_PICO . V 4 a" VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BPLB2016-0114
Property Address: 77655 CALLE CHIHUAHUA
APN: 774053001
Application Description: DAVIS / ABANDON SEPTIC/CONNECT TO SEWER
Property Zoning:
Application Valuation: $2,000.00
Applicant:
SUSAN C LUICCI-DAVIS AND HARRY DAVIS III
77655 CALLE CHIHUAHUA
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:
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
I, as owner of the property, or my employees with wages as their sole
a compensation, will do the work, and the structure is not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the improvements
are not intended or offered for sale. If, however, the building or improvement is sold
wit one year of completion, the owner -builder will have the burden of proving that
r he 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
the on, and who contracts for the projects with a contractor(s) licensed pursuant to
t ntraCtors' State License Law.).
f
am exempt under Sec. B.&P.C. for this reason
Owner:
L� l --
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
Lender's Ad
Owner:
SUSAN C LUICCI-DAVIS AND
77655 CALLE CHIHUAHUA
LA QUINTA, CA 92253
Contractor:
OWNER BUILDER
Llc. No.:
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9YP/2016�
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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:
Carri r Policy Number: _
I certify that in the performance of the work for which this permit is issued, I
all 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 -Z ��j� Applicant:
WARNING: FAILURE TO SECURE WO RS' COMPEN ATION 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.
114
Date: "��/�' Signature (Applicant or Agent):
Date: 9/22/2016
;'Application Number:
BPLB2016-0114
Owner:
Property Address:
77655 CALLE CHIHUAHUA
SUSAN C LUICCI-DAVIS AND HARRY DAVIS III
APN:
774053001
77655 CALLE CHIHUAHUA
Application Description:
DAVIS / ABANDON SEPTIC/CONNECT TO SEWER
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$2,000.00
Applicant:
Contractor:
SUSAN C LUICCI-DAVIS AND
HARRY DAVIS III
OWNER BUILDER
77655 CALLE CHIHUAHUA
LA QUINTA, CA 92253
-----------------------------------------------------
----------------------------------------
Llc. No.:
Detail: ABANDON SEPTIC/CONNECT TO SEWER. 2013 CALIFORNIA BUILDING CODES.
s
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT CITY
AMOUNT
BSAS SB1473 FEE
101-0000-20306 0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PERMIT ISSUANCE .
101-0000-42404
0
$91.85
Total Paid for PERMIT ISSUANCE:
$91.85
DESCRIPTION
ACCOUNT
CITY
AMOUNT
BUILDING SEWER
101-0000-42401
0
$12.09
DESCRIPTION
ACCOUNT
CITY
AMOUNT
BUILDING SEWER PC
101-0000-42600
0
$12.09
Total Paid for PLUMBING FEES:
$24.18
I LJ I HLJ: :>11 /.US
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Permit#;
Prof ct Address:
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City of La Quinta
Building 8t Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
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�t, ,lt.. Cni �VItkk. C Owner's Name:
A. P. Number.
Address: '7"l1e,J5
Legal Description:
�-
City, ST, Zip: �� y �aA z
ntractbr:
Telephone:
Address:
Project Description:
City, ST, Zip:
Telephone:
State Lic. # :
City Lic. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
h
Telephone:
one:
Lic.
Name of Contact Person:
_
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Cos cti n Type: e• Occupancy:
Y P
roJ'ecStoto
t type circle one • New Add'n Alter Repair. r
DemoP
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
46-p- �o - t-�
Estimated Value of Project a opt
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Clieck Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Tit!e 24 Cales..
Plans.picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"'.Review, ready for corrections/issue
Electrical
SubcontactorList
Called ContactPerson
Ph,mbinl�
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Reyiew, 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
78-495 CALLE 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 toworker injury.
Benefit/Risk: Hip_hest 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 SiQnifcant 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 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 Sienificant Financial Risk
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78-495 CALLE 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 toworker injury.
Benefit/Risk: Hip_hest 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 SiQnifcant 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 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 Sienificant 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 a 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 — unlicensedpersons frequently have the property owner obtain an "Owher-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
TWY 4 4 a, "
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 fora building permit has been submitted in your name listmi yourself as the builder of the property
improvements specified at —1-7 b�—S Call (%;( k %1NA In C CA 9aa�3
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
..iiDIIRECTIONS. Read and initial each statement below to signs you understand or verify this information.
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. 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.
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 risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
1 4. I understand Contractors are required by to be licensed and bonded in California and to list their license num
permits and contracts. bers on
l
5.'1 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.
W&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.
Ak7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residen
tial
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.
r
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 owners) that result from any latent construction defects in the
workmanship or materials.
k9. 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.
410. 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 f, r proposed cons�ction activity at the following address:
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41. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
appl able laws and requirements that govern Owner -Builders as.well as employers.
2. 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 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 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 verifuation 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
Permif 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 thepermit is issued to verify the property owners signature.
Property Owner's Signature: Date:
I COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL,
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Received From: ---/
Address: o � ,
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Account No. �[
!� L �" Lot (s)
Service Address
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❑ Meter(s)
❑ Service(s)
! ❑' Backflow(s)
'❑ House Lateral(s)
❑ Detector Check(s)
❑ Meter Surcharge
!!! anitation Capacity Charge
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❑ W.S.B.F.C.;
❑ Temporary Construction Meter
❑ Turn on Charge
❑ Uncollected Account - Name
f ❑ Inspection Fee - Tract -
Fee -
0, Plan Check Fees Water I Sewer -
Tract -
;❑
Bond Payment - A D - Bond
N? 95402
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Assmt.
❑ Customer Deposit
} ❑ Other s -
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` Copy to:
I NOrder
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ROSENOW SPEVACEK GROUP, INC.
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Nancy M drid
Project Manager
Enclosure
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Water Service I twIl
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., Cashier V
CVWD-438 (11/89)
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540 North Golden Circle, Suite 305, Santa Ana, CA 92705-3914, Telephone 714/541-4585, Fax 714/836-1748, San Diego 619/967-6462