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BRES2016-0182r i 4 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 4 COMMUNITY DEVELOPMENT DEPARTMENT .BUILDING PERMIT` VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Application Number: BRES2016-0182 Owner: Property Address: 78785 SANITA DR RUBEN RODRIGUEZ APN: 604162017 78785,SANITA Application Description: RODRIGUEZ / CHANGW OUT WINDOW AND DOOR LA QUINTA, CA 92253 Property Zoning: Application Valuation: $300.00 Applicant: Contractor: RUBEN RODRIGUEZ RUBEN RODRIGUEZ 78785 SANITA 78785 SANITA LA QUINTA; CA 92253 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:140528101253009827 Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that lam 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 ($5: ,00). ('m" as owner of the property, or my employees with wages as their sole ,01 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 o( -she did.not build or improve for the purpose bf.sale.). (W, 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 Dam te� -`� 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 Address: Date: 6/29/2016 (760)898-5997 Llc. No.::CONV:140528101253009827 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: ii r: Policy Number: _ �N ertify that in the performance of the work for which this permit is issued, I not employ any person imany manner so as to become subject to the workers' compensation -laws of.California, and agree that, if l should become subject to the workers' compensation provisions of Sectiom3700.ofthe Lab Code, I shall forthwith comply with those provisions. Date y �� , -30-14 Applicarn % " 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 Cluinta, 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. Fagree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this cit a er upo above-mentioned property for inspection purposes. Da t 5 _f LP Signature (Applicant or Agen ' Description: RODRIGUEZ]. CHANGW OUT WINDOW AND DOOR e_"s­'s_U a ry Type., - BUILDING, RESIDENTIAL L. Stat . us: LINDE . R . REVIEW Subtype: REMODEL. Applied: 6/29/2016. . SKH Approved: Site Address: 787 S S 'QUINTA CA 92253 Parcel- No:,.1504162017 8 ANITA dRIA' Subdivision: Block: Lot: Issued: Lot Sq Ft: 0 Building Sq Ft:,O Zoning: Finaled: Valuation: $300.00 0ctiJpa'ncyT.y0e- Construction Type: Expired: No.Buildings: 0 No..Stories: 0 -No..Unites: 0 Details: CHANGE OUT (1) WINDOW AND (1) DOOR. 2013 CALIFORNIA BUILDING CODES. APPLICANT RUBI .77 CONTRACTOR` RUBI OWNER RUBI g, Pro"ic", e_"s­'s_U a ry 78785 QU -:92253 -'�AltX INTA- A L 78785.SANITA. LA'Q0INTA CA: 92253' 787.85.,SANITA LA QUOtAl','*' Ifig—g-mmmmmamm "Y . - BS,AS SB1473 FEE 101-000.0-.203,06, 0 $1.60 $0.0.0 .Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $0.00: Printed: Wednesday, June 29, 2016 3:58:41 PIVI- 1 of 2 CRW"YSTFM I S Z.7 77 .77 'DESCRIPTION 7777T7777 ��AMOUNTI.'­ PAID _vl SMI RESIDENTIAL 101-0000-20308 0 $0.50 $0.00 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.50 $0.00 DOOR/WINDOW, 101-0000-42400 0 $60.91 $0.00 REPLACE FIRST 7 DOOR/WINDOW, 101-0000-42600 0 $110.22 $0.00 -REPLACE, FIRST 7 PC Total Paid for WINDOW/SLIDING GLASS $171.13 $0.00 'PARENT PROJEM DATE BOND INFORMATION Printed: Wednesday, June 29,2O1h3:58:41PK8 2cfZ COFWIYSTEMS 4 1 Qin # City of La Quin is Building.&, Safety Division Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and TrackngSheet Permit #78-495 .Proms ject-Address: 72 9, 0": STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CEC-CF1 R -ALT -01-E Revised 06/14)CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CF1R-ALT-017E Prescriptive Residential Alterations (Pagel of 4) Project Name: Date Prepared: A. GENERAL INFORMATION Ol , 01 Project Name: 02 Date Prepared: ` _ W 03 Pro ect Location: S n j � % a 04 "� Building Front OrienteUon (deg or cardinal): 05 CA City: A- C 06 Number of.Alt re d1P elling Units: 4'r 07` Zip Code: ' 08 Fuel Type: 09 Climate Zone: 10 Total Conditi ned Floor �Aiea (fgYP1 11 1 Building Type 1 .12_ SIab)A°rea it!)' 13 Project Scope: l .. DING INSULATION DETAILS (SectioJn 150.2(0)1) Ol 02 03 :.04 OS 06t 07. 084pf M09 ^ 10 11 Tag/ID Assembly Type Frame Type Frame Depth (inches) FrameContinuous Spacing (inches) P,roposed Required Comments Cavity nsulation R value R -value > Uafactor Appendix JA4 ;Reference U -Factor Table. Cell. . "r _s k '57. V NOTES T •. Roof area coveredby building integrated photovoltaic panels and solar thermal panels are exempt from the above Cool Roof requirements. • 'Liquid,field applied coat egs must comply with installation criteria from section 110.8(i)4. REPLACEMENT (Prescriptive Alteration, S� i67n B_6 .2(b)1H)' 060E 01 02 03 .04 05 06 07 08 09 10 11 12 13 Method of Compliance Roof Pitch Exception CRRC Rrroduct ID Number a ,,P,rgduct Type . R -value DeckInitial Insulation t Propos d Minimum Re uired Solar- Aged Solar Thermal SRI Aged Solar Thermal SRI Reflectance Reflectance Emittance , (Optional) Reflectance Emittance (Optional) k '57. V NOTES T •. Roof area coveredby building integrated photovoltaic panels and solar thermal panels are exempt from the above Cool Roof requirements. • 'Liquid,field applied coat egs must comply with installation criteria from section 110.8(i)4. Registration Number: CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: HERS Provider: June 2014 STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CEC-CFIR-ALT-01-E Revised06/14 CERTIFICATE OF COMPLIANCE Prescriptive Residential. Alterations Project Name: D. NESTRA I ION/GLAZING AREAS ALLOWED (Section 150.2(b)1I 04 01 02 03 Alteration Type • Orientation,. Maximum Allowed ft2NX Comments rr CALIFORNIA ENERGY COMMISSION CF1R-ALT-01-E (Page 2 of 4) Date Prepared: E: F NEST_ RATION/GLAZING PROPOSED AREAS AND EFFICIENCIES (Section 150.2(b)1) �. 01 02 03 04. 05 06 07 0,8 10�`w 1 12 13 14 15 a Combined Orientation Area Area t Net Maximwm Exterior SHGC. from Tag/ Fenestration Frame =• Dynamic N, S, W, E, or Removed .Added Added Area Allowed or Shading ID Type Type I Glazing Roof ft2 ft2 ft2 _ 1p;fac U -factor Source SHGC Source Device CF1R-ENV-03 W a Net Added West fa ng FenestrationArea i, b Existing + Added Westfacing Fenes�tratior, a c Maximum AAIIlow West-facingOF,ene tration Area ligy ,d d Is West -facing Fenestration Area < Max uum Allowed Westw acing Fenestration e A e Net Added Fe Wtrati& Area (all or entati n .: _ f Ez sting + AddedfRe tration Area (a) ons) �onen�ta g Maximumllowwededdke estration Area (all o it entations) h �Z, �� Is Existing +-gdded Fenestration Area < flaximum Allowed Fenestration Area (all orientations) 0 Registration Number: Registration Date/Time: HERS. Provider: CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014 - STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS . CEC-CFIR-ALT-01-E Revised 06/14 CERTIFICATE OF COMPLIANCE Prescriptive Residential Alterations Project Name: SPACE CONDITIONING(SC) SYSTEMS CALIFORNIA ENERGY COMMISSION C F 1 R -ALT -01- E (Page 3 of 4) Date Prepared: EATING/COOLING (Prescriptive section 150.2(b)) 01 Ol 02=. 03 Dwelling Unit Name Dwelling Unit CFA (Ft2) Com ntW n. 06 07 . WATER HE SYSTEMS (Sectiori 150.2,(b)G) 01 .02 03 04- 05 06 07 . 08 Q9,% p 10 . a7%1 3 12 13 14 15 Heating N of Water . Name 0 . ..141 entification or Name Conditioning System(s)? Comments d� Water System Water Water Water Heater Rated Ra'te'd - Heating Heng D Exterior Back -Up Solar Dwelling Unit DHW Heaters Storage p�u N Identification or Heating Heater in Volume "Fuel Input Efficiency Efficiency .-Standby Insul. Savings Central DHW System System Name System Type Type system I (gal) I Type Type k Value Type: Value- Loss (%) R -Value Fra&ion . Distribution Type Distribution Type SPACE CONDITIONING SYSTEMS °AND WATER TING SYSTEMS IN MULTIFAMI%D FLING UNITS 01 02 03 t � 640V 05 06 %Cent�aWaterNeating Dwelling Unit TetaIVIGFA System Identification or Dwelling Unit I ater Heating System Dwelling Unit: Alteration to the. Space e,. Dwelling Unit Name (f%2) ___ . Name 0 . ..141 entification or Name Conditioning System(s)? Comments d� Registration Number: Registration Date/Time: HERS Provider: CA Building Energy Efficiency Standards - 2013 Residential Compliance -June 2014 STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS .CEC-CF1 R -ALT -01-E Revised 06/.14 CALIFORNIA ENERGY COMMISSION v CERTIFICATE OF COMPLIANCE MR -ALT -01-E Prescriptive Residential Alterations (Page 4 of 4) Project Name: Date Prepared: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT,,, 1. 1 certify that this Certifieate.of Compliance documentation is accurate and.complete.dq Dotumen n A thor Name: tGzIry Docu nt io uthor gna re: �eti Company:' Sign t e ate.%' y °S Address: - CEA/ HERS Certification lder ifica[iioon(if.applicablel: City/State/Zip: C: c�� K-1 a C �+u� Phone: tri RESPONSIBLE -PERSON'S DECLARATION STATEMENT ' I certify the following under penalty. of perjury, under the laws'of the State of California. 1. The information on this Certificate Compliance is true'and correct provided of 2. 1 am eligible under Division 3 of the Business and Professions Code to accept.respons blll y:forthebuilding deslg"'�,n orsystem design ideritified on this Certificate of Compliance (responsible designer). 3. That features specifications, the energy and performance materials, comp6n4 n-ts, nd manufactured devic 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 Ca fornia Code of'Regulaiions. 4. The building design features or system design features identified :on�thl eertifcate of�Co pliance are consiste ith tl a information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the en orcement age ey for approval with thls,bullding.permit application. lliw ble with pg it(s).issued 5. 1 will ensure that a registered copy of this Certificate of Cor�lplianceashall.be made auk the build for the building, and made available to the enforcement agency for all applicable inspections. l understand that a registered copyof this Certificateogf Compliance is required'to be included with the documentation the builder provides to the building owner at occuDaKy., ' Resp si D igner N me: , � , Responsible Designer Signature: Co any : " Date signed: . 0.���: Address:) /�� �\ / 2> �t lti�' r ( � License: . City/State/Zip: Phone: O 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 June 2014 06/29/2016 16:18, 7603459882 GENERATIONS WEST PAGE 01102 Generations West GENERAL CONTRACTING, KITCHEN & BATH REMODELING CA License #599361 39-750 Garand Lane Suite B Palin Desert, California 92211 Office 760-345-9898 Facsimile 760-345-9882 Email info@generationswest.com 6/29/16 Hi this is what I could fqd in my book the U value is located towards the bottom. Thant: you Michelle Blecka 06/29/2016 .16:18, 7603459882 GENERATIONS WEST PAGE 02/02 I ABS - AMERICAN BUILDING S'UP'PLY, INC. I FIBERGLASS TESTING RESULTS .y ETC Laboratories Certified By NFRC ASTM D1761 - Screv�ib_ol.ding Capacity. Test. • Minimurh-Goad 450.jb. Distinction Door, Loads `867 lbs ASTM F145'Sec 7.3;- Door Static Load :Test • Minimum Load' ``' ` . >. 9,000: lb. • Distinction .Door Loads":2; 469 lb. ASTM_D-'1666 - Machining Test" Meets requirements: on drilling, routing; boring; sawing;; planing and chiseling AIM,.. E26.3 -Air infiltration • Test Pressure 1.57 0.5;f..(25 mph)'' • Results 0.10 scurf/ft NFRC • RValue 6.67 Los Angeles 11/30/15 Phone: (909) 879-8730 PLASTPRO Fiberglass Fax: (909) 879-8705 Page 3 BUILDING,& SAFETY DEPARTMENT 78-495 CALLS TAMPic6 (760) 777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 Considering Becoming :an Owner B jId"er? 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 managdmenf,.kriowledge, workmanship, and completion of the job. You benefit by not paying others to perforin this work for you and your risk depends yourown 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 yourown General Contractor, the permit is. taken out in your name and you hire California licensed subcontractors 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 anyvnlicensed'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 Siknificanffinancial 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 P:O. BOX 1504 LA QUIN:TA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 TY 0' BUILDING & SAFETY DEPARTMENT (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 eemit has been subniitted in your'' name li g yourself as the builder of the property improvements specified at �`� S ' � %� til ��� h A ; C. We are providing you with an Owner Builder Aclaiowledgment and InforinatibnVenfrcation<Form to make you aware of your responsibilities and possible xisk you may incur by having this perrmt issued m your name;astthe Owner -Builder. We will not. issue: a building:permit until you have read,.mitialed 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 perrnitting authority. Iv 1V LiL` LV1V1P 1\ 1. 1PUN and initial, each statement below to sign fy you understand -or verify this information.. V1. 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 dt her own.laboi and material personally. 1, as 4. 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. I understand building permits are not required to be signed by property owners unless they ale 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 baving,the permit filed in his or' her name'instead of my own. 1 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 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. 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. 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. Fl­`*'L8- 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. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party, 1gall n financial) res,00n_sible 1/ for ro osed copi• truction activityat the ' followingaddress: ' � SQ k Ic.p 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. 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. n Signature of property owner)dA�� 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 verify the property owners signature. Property Owner's Signature: Date: