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13-1364 (RER)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 13-00001364 Property Address: 51150 CALLE OBISPO APN: 770-142-003-93 -000000- Application description: REMODEL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 6500 T4tyl 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: TERRY TRYON 51150 CALLE OBISPO LA QUINTA, CA 92253 (760)485-6601 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Contractor: Applicant: Architect or Engineer: Owner \NV�-' :OCT CITY QF LA QUINTA - - - - - - - - - - - - 7 - - - - I LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 fcommencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: .License No.: Contracto r:' OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt'frorn the Contractor's State License Law -for the following reason ISec. 70 . 31.5, Business and Professions docle: 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 t6file a signed statement -that he or she is'licensed pursuant to the provisions of the Contractor's State License Law'lChapter 9'(comme,ncing with Section 7000) of Division 3 of the Business and Professions Code) or that he. ,�,?�she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by -y- oplicant for a permit -subjects the applicant to a civil penalty of not more than five hundred dollars ($560).: ol 1, as owner of the property, -or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale fSec. 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 arencit 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.). K., '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 (��Ac_, pursuant to the Contractors' State License Law.). 4 ' am exempt under Sec. B.&P.C. for this reason )ate: 62.S_�- J_3 Owner.--qt�� 4 ::� 6� N LENDING AGENCY ',�,.SAIUCIII 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: \J v LQPERMIT ----- 1_� -------- WORKER'S COMPENSATION DECLARATION Date: 10/25/13 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, 13700 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 Gt,gek;64-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 370 , 0 of the Labor Code, I shall I hwi . th comply with th h d h ose P visions. D'attey t Appfica WARNING: FAILURE TO SEC U 0', ' 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 �ODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety 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 p ermit 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 county to enter upon the above-mentioned property for inspection purposes bafg?:� ��Anature (Applicant or AgeC�� ck I Application Number . . . . . 13-00001364 Permit . . . . . . REMODEL 2013 Additional desc . . Permit Fee . . . . 70.07 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 4/23/14 Qty Unit Charge Per Extension 1.00 60-.0600 LS MISC DR/WIN, NEW, FIRST 60.06 1.00 10.0100 ---------------------------------------------------------------------------- EA MISC DR/WIN, NEW, ADDL 10.01 Permit . . . . . . REMODEL 2013 Additional desc - - Permit Fee . . . . 21.45 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . - 4/23/14 Qty Unit Charge Per Extension 1.00 21.4500 ---------------------------------------------------------------------------- EA MISC REMODEL, ADDL 500 SF 21.45 Permit . . . . . . MECHANICAL 2013 Additional desc . . Permit Fee . . . . 11.92 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 4/23/14 Qty Unit Charge Per Extension 1.00 11.9200 --------------------------------------- EA MECH APPL REP/ALT L ------------------------------------ 11.92 Permit . . . . . . ELECTRICAL 2013 Additional desc . . Permit Fee 23.83 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 4/23/14 Qty Unit Charge Per Extension 1.00 23.8300 LS ELEC FIXTURES, FIRST 20 23.83 --------------------------------- ------------------------------------------ Special Notes and Comments REMODEL - INSTALL (2) DUAL GLASS WINDOWS ON THE EXISTING EXTERIOR WALLS. REPLACE EXISTING ALUMINUM FEX AIR DUCTING. RELOCATE EXISTING ELECTRICAL LIGHTING IN KITCHEN AND LIVING ROOM. INSTALL NEW R38 & R13 INSULATION -IN KITCHEN AND LIVING LQPERMIT Application Number . . . . . 13-00001364 ---------------------------------------------------------------------------- Special Notes and Comments ROOM AND REPAIR WATER DAMAGED DRYWALL. --------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) ------ 1.00 PLAN CHECK, ELECTRICAL 23.83 PLAN CHECK, REMODEL 132.99 PERMIT ISSUANCE M/P/E 90.57 PLAN CHECK, MECHANICAL 4.77 STRONG MOTION (SMI) - RES .65 Fee summary ----------------- Charged ---------- Paid ---------- Credited ---------- ---------- Due Permit Fee Total 127.27 .00 .00 127.27 Plan Check Total .00 .00 .00 .00 Other Fee Total 253.81 .00 .00 253.81 Grand Total 381.08 .00 .00 381.08 LQPERMIT '-4. Bin Ot Qu _y Qf.�4_ "Inta .-BtJ11d1njk�Aety- ivision P - . 0. 'Box 1564, 7#�445- c �iie Tampico 69 C " ::"(766)� 777-7 1,2 -��Q A �3251- 0 fiffqifi�-,Pe'rmit.�,p io, -,,Traeking Sheet plidt n and, Permit # INA Project Address:,64 1 S. ;4L,. 0� ------- A.P!-N�;r�ber'�: V AoAss: 541Cn I Legal Descrip�i6h- -city, �T'�Zi Contractor: K3 uj #--J -e A n letdpho"e: Address: ion: 1 City, ST, UU Mdn Ii"s a At -r"),v IC- j Z Telephone: State Lic. # city tic. 0.. 20 Arch., Engr., Designer: A., Address: A - ',e'Aie. v S , / Ve-K_ City., ST, Zip: tie -K - Telephone: Stat e Lic. #: ............ Name of Contact Person: C fistruction'W4e:.. Occupancy: Pr'jca�t�y e (circle one): New Adid'n Alter (�RepDerrio' 0i p Sq. Ft.: # Stories: J # Units: Telephone #,of Contact Person: Estimated Value of Project.O&S 0 �C_l APPL.ICANT: DO; NOT. WRITE�- BELOW -THIS LINE 0 Submittal Req'd Recld TRACKING PERMIT FEES, Plan Sets Plan Chick submitted Item Amount' Structural Cates. Reviewed,reidy,for,.coirections Plan Check Deposit Truss Cates. Called. Contact Person Plan Check Balance. Title 24 Cates. Plans picked up Construction Flood plain plan '..Y Plans resubmitted Mechanical Grading plan 2.d Review, ready for corrections/issue Electrical Subcontactor List 'Called* ContactPersqn Plumbing Grant Deed lans picked up S.M.1. H.O.A. Approval .,Plans resubmitted 'Grading IN HOUSE:- .3rd Review, ready for 6rrc ctions/inue Developer Impact Fee Planning Approval Called Contact Person, A.I.P.P., Pub. Wks. Appr Date of permit issue SchoolFees Total Permit Fees Lt 4 K, .4 -%I# L4j' RAI t.,t4t( a's IJA &^ s. I 'I L I I T� ri CITY o'F ............ � QUINTA BUILDING APp & SAFETY DEP-r, C"jy '3U, ROVED IN i No iT 7:3 r � tv -Y OF LA QUINTA F- BUILDING & SAFETY DEPT. APPROVED [[�ATE T'l J - %A PTIL Prescriptive'Certiricate of Cornjillincei Residential CF -111 -ALT Residenfid A UeM ons age I of 5) A . Project Namj;-,,. Clim N of sto*iks General Information SAW A eb &1.2 &1 b Date: nforrcment Agency. Building Type 1311!5�gle Farnil'yo Multi Farnib�"'r-5 Circte.tl� Front Orientation: N. F_ SCW)or degre'es Conditioned Floor Arta (CFA): Piojec:t Type:; - 0 Alter0ions 0 En'vcl* 0 Feneslyewn 0 Roof 0 HVAC L M ReOtaccruent orChanpe 04 lik6uci-Rrplacement- 0 Water Heater �Y=_- Th'slor"t Is nO(10 be usedfior.New� Coitsiruc(ed Buildbig4or Ad4ldons Insuladon.Values For OpaqueSurfaces (for Furring use thewass mod Furring Stryn-Consftwiton table below) Assembly Alteration 0.0pening o(framed cavity siloat - Alterations that irrvolve the opening of theframedc . a�ity ofa wall. ceiling. orfloor nnist install the -MKWOIY MWMUM innlation value per f 150for the altered assmbl Fill in Columns A -C and enter man4wory insulation vahie in Colmn H ' y- O'Repla"meat of entire assembl' , . I .y -Re&cement ofan entire wall., ceiling, orfloor assembly requires the installation ofComponent I - D insulation values in Table 151 -C. Fill in Columns A - J. OpaqueSa are Details Forthe furred portioned,of Mass. Wa Tabk below. ussee Forrint,S.trips Construction A] B C D' I J -P Stan rd Values From JA4 Table Framing Ta q Assembly Name Material ID dEr 112L and'sizc2 Thickness. Framed " Continuous JA4 Proposed Sp&6ng. U- JA4 Table Ca-6ty, ln�L� Assembly. Assernb� or OdXr' factor' Nuthbti' R-valu6' R-Valui? Cell Value U_&clor F;, H: :1, 1 J K L M - PrOPOsed.Pr*Pcrties of Masonry and. Concrete Waits From Reference. Joint A ppendix Table 4.3.5,43.6 4-3.7 Added 0, C C: Interior or Eit"r insulation i 'Furring $pace 6om Refirrucc Joint Appendix Table 4.3.0 t 0 > LU F�Zal mb�. Assembly. U4actor Comment Noa Forfirmdmwmblwsamow"forConamimuinmdanonR-v&ue..we'pagtrJA4-3and-Equation4-1. Forcalcidatinfw.redwoWumdocAAmand Fw7ft Conoruaim &We bdow. 1. For TaglID Lndicate the identification name that matches the building plans - 2. Indicate the Assembly N�me or Ope: Roo)9Ceil* Walls, Floom -t C In' cate the Frame t"x and Size: For W0014 Metal Uetal Buildings. Mass, enter � 2w. 2x6. or eic--.- sic JA4for otherpossibleframe type assemblies. 3. EAter the thidawnfor mass in inches or 4-cing betweenframing members enter. 16 "or 24 "OC. or Othirfor all other assembly description nich as Concrete Sandwich Panel, Spandi-el' Parwl. Logs. StrawBale Panel and eir.... 4. Based on the Climate Zone: e nier the Standard U -factor fi-ont 7:01c 15 1 - A C or D for each differe nt assem bly, Name or I"M. 5. Enter the Table number that closely resembles the proposed assembly. 6. Enter the R -value that is bein g installed in the,wall cavity or between thefiaming, otherwise. ejaer -0 7. EAter the Continuous Insulation R-valuefor the proposed assembly; otherwise.. ewer "0 8. Enter the row and column Ofthe (1 -factor value based on Column F Table Nwnber and enter . the Assembly U -factor in Column J 9. The ProPosed Assembly U-)bc(or, Column J. must be equal to or less than the Stan&rd U -factor in Column E to comi*- Furring Strips Construction Table.fa�, Mass.Walls 1� A . I B . I C : I D I 'E F;, H: :1, 1 J K L M - PrOPOsed.Pr*Pcrties of Masonry and. Concrete Waits From Reference. Joint A ppendix Table 4.3.5,43.6 4-3.7 Added 0, C C: Interior or Eit"r insulation i 'Furring $pace 6om Refirrucc Joint Appendix Table 4.3.0 t 0 > LU F�Zal mb�. Assembly. U4actor Comment Mass Thickness' U. Assembly Name or JA4 Table 7;j Typez NuznbeT3 :5 > 7 F_ Registration Number: 2008. Residential Complianee Forms Registration Date,time: HERS Provider: August 2009 Prescriptive Certificate of Compliance: Residential CF -IR -ALT Residential A Ueration's age 5 of 5). Project Name: Climate N of Stones I <, — 9 -,1,) W c- 16 T: �Xj 4 HERS VERIFICATION SUMMARY 77ie enforcement agency shouldpays'pecial attention to the HERS Measures specified in this checklistbelow A completed and signed CF -41i Formfor all the measures specified shall be submitted to the building inspector beforefinal inspection. Duc ' t Sealing & Testing HERS.verficiaiion is requiredfor this measure. 13 YES E3 NO M: In Climate Zones 2 and 9-16, if more than 40 11 feet of new or replacement ducts are installed in unconditioned mew space, the du�u are to be sealed per'§152(b)lDii and the newly installed ducts. are to be insulated per §151(f)10. [3 EXCEPTION: Existing duct systems that are extended, which ire constructed, insulated or sealed with asbestos. DYES ONO YES: In Climate Zones 2 and 9-16, if the existing space -conditioning system (HVAC equipment and ducting) is replaced, the ducts are to be sealed per § 152(b) I Di. [3YES ONO YES: In Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler, outdoor condensing unit of a split system, coolin or beating 6oit,.or the furnace heat exchanger) the ducts are to be Ing sealed per §152(b)IE. [3 EXCEPTION- Duct systems that are documented to have been previously sealed confirmed through I-EERS verification in accordance with procedures id -the Reference Risidential-Appendix RA3. [3 EXCEPTION: Duct systems with less,than,40: linear feet in, unconditioned space- rl EXCEPTION: Existi ng duct systems constructed, insulated or sealed with;asbestos. Refrigerant Charge- Split System HERS verification is requiredfor this measure DYES [3 NO YES: in Climate Zones.2 and 815, when t.heexisffi'% RVAC equipment is replaced (including the replacement of the air handier, outdoor condensing unit of a split'system A/C or heat pump, cooling or beating coil, or the furnace heat exchanger) a refrigerant charg� menuretnent shall,be verified per § I 52(b) I F. Central Fan Integrated (CF1) Ventilation System and Fan Waft Draw ve on requirements of § I 50(o) do not apply to existing residential homes. Ducted Split Systems - Air Conditioners: and Heat . Pumps: Airfl6w HERS verification is requiredfor this -measure. 13 -YES [3 NO YES: In Climate Zones 10 through 15, when the existing spaoc-conditioning system (HVAC equipment and ducting) is replaced, the airflow.and fan watt . draw shall be verified per § 152(b)l Ci to meet.the requirements of § I 51(f)7B. I Documentation Author's Declaration Statement I certify that this Certificate of Compliance documentation is accurate and complete. Name, SignatureL----,-' Com- Pally -Date: Z'a Address: IfApplicableUCEAor �CEPE� 611S'c-> City/State/Zip: -(Certifica(ion Phone: �76g�s Responsible Building Designer's Declaration Statement 9 1. am eligible under.Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on this Certificate of Compliance. 0 1 certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform to the requirements of Title 24, Parts I and 6 of the California Code.of Regulations. 9 The building design features identified on this Certificate* of Compliance are consistent with the information, provided to document this building design. on the other applicable compliance forms, worksheets, calculations, plans and specifications submitted to the enforcement agency for apgroval with this building permit app . lication. Name: Si Zz 040-,M/ Comowry Date: A0* - Address: License: /— A 5 City/State/Zip: Phone,,L, A - 4 -.6 For assistance or questions regarding the Energy Standards, contacf-the Energy Hotline at: 1-800-772-3300. 2008 Residential Compliance F�rms March 2010 'Prescriptive Certificate of Compliance:" Residential CF -1R -ALT Residential Afterations age 2 of 5) Project Name- Climate Zone N # of Stories Mass and Furring Strips Consirmcdon (footnotes)' 1. Indicate the Ope ofassembly to include; Hollow Unit Masonry Walls. Solid Unit Masonry, Solid Concrete'Walls, Etc. Additional assemblies can befound Reference Joitd-AppendirJ,44. 2. 77iis is the U -Factor based on the thickness ofihe assembly in inches. 3. 77te R -value ofthe insulation to be a&kd on the interior or exterior ofthe assembly. 4. 77te Calculated R- Value is the R -value ofthefiared out section ofthe:assembly. 5-6 7he Final Assembly is calculated using Equation . 4-2 or Equation 4-4of th�'Reference Joint Appendix JA4. 7he equation is the inverse of Cot DaddedtoColumnf. Column K is the in'ver-sefi-6m.columnJ 7. Insert the calculated U -factor value on to the Opaque SuU2rce Details in Column J FENESTRATION PROPOSED AREAS OReplacing window alone –'Replacement wbulaws shall meet -the U-FactorandSHGC Value requirements of Component Package D in Table 151-C 77te T61al Fenestration and West-facingAred requirements ari? not applicable. OAdding 50fe or less of window area – Newly insialledwindows-sMil meet the U -Factor andSHGC Value requirements ofConWnent Package D in Table 151-C. 13Adding more than .50fe of window area – Newly installed windows ' shall meet the U -Factor, andSHGC Value and the Fenestration Area requirements of Component Package Din Table 1517C Completethe Altered FenestrationAllowed Area Table on Page 2 of the CF -JR -ALT Orkntaoon D Fenest-ation Type and Frame (Norik East. ProrsedArea' Maximum Maximum (Window, Glass Door or Skyl ight) South West) (fe) U -factor' SHGC,�_ 1. 4 NFRC or Default Value5 1J_PCC 7— G I%I&A 7k– 0 i 7 CFA of Allowed Existing Allowed 1. Fenestration area is the area of total jlazedpr6duct (i. e. glais plusftame). Exception: When a door is less than 501196 glass, thefenestration area maybe the glass area plus a 'T inchftame "around the glass. 2.,Enter valuefrom Component Packdge D Requirements in Table 151-C 3. A clualfenestration products installed and as indicated in CF_6R_&VV Form shall be equivalent to or have a lower U-Jactor andlor a lower SHGC value than that specified-bn the CF- IR ALT,�orm. 4..Submit a complited WS -.3R Form if a redu6ed SHGC is calculated with exterior shading. 5.#'applicable at -this stage enter "NFRC"Jbr-NFRC Certifiedwindo I ws-oraiv�CI�C "Default" valuesfoundin Table 116-A orB. ALTERED FENESTRATION ALLOWED AREAS (ConWide ifmori4han 51V?�offenestradon.is added) A B C D E F G CFA of Allowed Existing Allowed Entire %of Fenestratibn Area Fenestrati6n. Area ProNsed Area" 'Dwelling CFA?_� 3 Area� 'Removed' Area Added� (A x B) (E -D) + C Total Fenestration West Fenestration Area (Required In CZ's 2, 4 & 7 -15) 1. Yhe Proposed West FenestrationArea includes West -sloping skylight w�ea.anidany otherskylight area with a*itch less than 1:12. P 2. Enter 201*6 when no West orientation restrictionor 15% whenWestfen.estration . is being.installed in Climate Zones 2, 4. & 7-15. Note that the maximum allow ' edJenestration can only be 5% of the &A as indicated in Cdlumn'F, Cohimn G must be equal;to or less than Cohimn F. 3. 'In �limate zones Z 4. 7-15. no'More than 5% of the CFA is allawedfoi,-.�est-facing' glazing. 4. Existing Fenestration area must be counted toward the maximum allowed 15% or 20*10 ofthe whole building and calculated in Column G. 7he PioposedArea must be.less than or equal to Column F. - ' 5. Enter. thefenestration removed as Joari ofihe alteration ifany in column D. 6. Enter the Fenestration area that is bei ng added as part ofthe alterat'ion. 4. k P.0��Bpx 15041 LA QU.tiqTA:�,.CkL[FO'RNIA'-02247-1504 ButL6ING & SAFETY DEPARTMENT 78-495 CAL , LETAMPICO (760) 777-3012 LA QUINTA, CALIFORNIA 9,2253 FAX (760) 777-7011 � _. 1. V ACKA( PROPERT Y.'' OIN � ' S_ P Disdositres & Foriiislor O'W' AT`ek�Biifiaeri A pp yp�g, 9r, ons ruWon, Permits nhwogzav NORCETOTROVERTY.0 Dear, Property Owner An. application for -a building., permit has- been'�subniifte4-�in yo narae urself as the builder of the-Troperty T-3 imprGvements specified:at-- We �are-providmg. yoti vnth an-IOwner-'BtiiWr Ack6w.le& caridlnf ficii�;Vehfici T "to, make you awamof your orm.: responsibilities-and-O.ossible fisVydu v�iiy.-,inourby haivir*.,dIiS-pe'fmIt'isSUiW. ifi�vour name-as,tW'- - Owner -Builder. We Will.not [SSW, M ...:_ Wd J I�indmi' rovision, 1", , VC Ir ihifi" y6ui: %W4,1 g of eack'p Sig' ned, and returned this form to -us at. our official addie'ss'Indicated.'An a of �*the'�: t", exedute -thit .-notice' owner cannb gent unless You, the property owner, obtain ihe prior approval of the pernut,tingauthority. R�ad aM &idicd' e- 4901�i understanda. frequent practice of. unlicensed &rtons,is'to. have. the prdoerty-dwner obtain an "Owner-Buildee' pe "building.pe`iffinii-iti tfiai`,_6rrne6 usly�'iifiplies that lhe;property dw-ine-r. is prib" vidifik' -his of h�i-own labor �nd material personally. 1, as an Owner -Builder, may be held liable -and siibje6t to serious ill,risk, -for any.,injuti, �ustained byan unlicensed persoa and his or her employees, while working � o 'M ` 'h r, A. my property. I y pmeowne :s instu'ance. may - ribA.. provide coverage for those injuries. I am wilthmy actin, g a's an Owner-Builider and " awire o . f the limits of e Am my insuranc %coverage for injuries to workers on my property - 2. 1 understand building permits are not required, .be'sig�n -,to .ed by 'property.owners unless they are responsible for the construction and are not hiring a .4cehied.Contractor, to assume, this respe iAty;;. I understa44:as an.'.'O"�iner.�Buildeel I am-tfic-i 1�� of.recor prithe,permit'.1 understand that I �nay protect esN filedin sorhernameinsteadofmy I risk by hiring a licenSi;d_C6"` havi myself from Potential financia" atractor and ing the permit own. e'4 1 understand Contractors are,*required by law tob� -licensed and bonded in California and to list their license numbers on rinits and contracts. 5. 1 understand if I employ orpther'Wise, engage any persons; dther,thari California licensed Contractors, and the total value of my construction is at-Jeast five* hundred dollars -($5 , 00), including, labiouand materials,J xnay,be considered an "employer" under state and f6deral law. I understand if .1 ani,pprisidered W er state,,and cfedpral, law, A...must' register with the. state,and federal -an -e loyer7,und government, . withhold payroll- � taxe s, I proviide woikers,', . c . ompensat! ute to une loyment on.,diiabilit', insurancei ano-contrib ,y mp compensation- for each "employ 'also'und6rs.ta�ia-"-'m'y.t,,;Litu'r'e* to'--a�i"d"e by" the'se laws may subjecurne to serious financial risk. 4:1��-7_ 1 understand under California Contr'actors'. State License Law, an Owner -Builder who builds single-family residential structures cannoiAegally build, them� with th',' 'work intent to offer them fori sale" unless, all -is performed by licensed subcontractors and the number of -S"ctu're's'does'novexceed four within any calendar year, or all of the work is performed under contract with 'a licensed general building -Contractor. - e * .0 8. 1 understand as an Owner -Builder if I sell the property for which this permit is Lssmed, I may be 110-d liable., for any financial or personal. ii�uries sustained by.any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 9. 1 understand I may obtain more information regarding my obligations as an "employee' from tht Internal RID-WITUC 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 I- 800-321 -CSLB (2752) or www.cs1b.ca_gov for more information about licensed contractors. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the phrty legally and financially responsible - for proposed construction activity at the following address: I L I agm that, as the party legally and fumacially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. — 12. 1 agree to notify the issuer of this form immediately of any additions; detetions, or changes to any of the inF�011 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 COUM It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured wbile working on your property; you may be hc4d hab* for damages. If you obtain a permit as'Owner-Builder and wish to hire Contractors, you will be responsible for verUyiag whether or not those contractors are propedy licensed and the sutus 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 issuiltg,the permit Note. Acopy of skeproperty owi!er's driyer's Atensei f"M ft0ftr19a(&W4 or other verification acceptable to the agency is required to be presented when the permit is issued to vc?* (he PrVer(Y owner's signature. Signature of property owner Date: D Note: Thefollowing Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to applyfor a construction per7nitfor the Owner -Builder. AUT110RUATION OF AGENT TO ACT ON PROPERTY OWNER'S BEAUF 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 necmary 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 pedury 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 ofthe 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: