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BRES2016-011278-495 CALLE TAMPICO Ct Q D LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT. Application Number: BRER2016-0112 Property Address: 54020 AVENIDA VELASCO APN: 774215001 Application Description: FREASE / REROOF WITH ASPHALT SHINGLE [CRRC: 0890-0006] Property Zoning: Application Valuation: $2,000.00 Applicant: LILLIAN FREASE 14025 SW MCCABE CHAPEL RD DEC -0 8 2016 NICMINNVILLE, OR 97.128 CITY OF LA QUINTA DESIGN AND DEVELOPMENT DEPARTMENT 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.: _ 7 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 perm; ubjects the applicant to a civil penalty of not more than five hundred dollars (71, 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. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (� I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. . B.&P.C. for this reason &Date: ;Z01�o Owne : 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 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/8/2016 Owner: ARTHUR FREASE 14025 SW MCCABE CHAPEL RD MCMINNVILLE,•OR 92253 Contractor: OWNER/BUILDER, Llc. No.: 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 Xt�e for which this permit is issued. have and will maintain workers' compensation insurance, as required by Se3700of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: Policy Number: _ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree.that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.. Date: —, w/ P Applicant<�%I�� a 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 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 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 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. Date:/1—L zd Signature (Applicant or Ag $ (/ Date: 12/8/2016 Application Number: BRER2016-0112 Owner: Property Address: 54020 AVENIDA VELASCO ARTHUR FREASE APN: 774215001 14025 SW MCCABE CHAPEL RD Application Description: FREASE / REROOF WITH ASPHALT SHINGLE [CRRC: 0890-0006] MCMINNVILLE, OR 92253 Property Zoning: Application Valuation: $2,000.00 Applicant: Contractor: LILLIAN FREASE OWNER/BUILDER 14025 SW MCCABE CHAPEL RD MCMINNVILLE, OR 97128 �.Y.., r--� rte• + ] Llc. No.: ———————"#— ——C ——r--——=————————"""""——————-————————'————— �Q + Detail: REROOF WITH OWENS CORNING ASPHALT SHINGLE - ORANGE/AMBER BLEND COLOR [CRRC: 0890-0009] 2013 CALIFORNIA ENERGY CODE. .a r ti ..�c v ■ BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT RE -ROOF - FIRST 2,000 SF 101-0000-42404 0 $51.68) DESCRIPTION ACCOUNT QTY AMOUNT RE -ROOF. - FIRST 2,000 SF PC 101-0000-42600 0 $103.36 Total -Paid for RE -ROOF: $155.04 DESCRIPTION • QTY PAID PermItTRAK } , ..� n 6E0 �BRER2616=0112 AVENIDA VELASCO ' A n: 774215001 p z �. p �. �$1 p �` 56 4 ,roAddress .54020 C _ ♦ 1 •'.. [+ i � A. mak ..e. Y.- .� .p a r. BUILDING STANDARDS ADMINISTRATION BSA P s u b a' r g r .� ' w f a?rf$100 BSAS SB1473 FEE 101-0000-20306 0 r- $1.00 RE=ROOF , u. - s''- aW u " RE -ROOF -FIRST 2,000 SF 101-0000-42404 0 $51.68 RE -ROOF -.FIRST 2,000 SF PC 101-0000-42600 0 $103.36 TOTAL1 0. DEC 0 S 2016 CITY OF LA OUINTA ; DESIGN AND DEVELOPMENT DEPARTMENT �• , Date Paid: Thursday, December 08, 2016 ` Paid By: LILLIAN FREASE Cashier: AOR Pay Method: CASH - Printed: Thursday, December 08, 2016 9:58 AM 1 of 1 k,VY�TFs , Bin # Permit # �?otb•o���-- Project Address: SC} .Mo City of La Quin to Building 8i: Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-701,2 Building Permit Application and Tracking Sheet vetituo Owner's Name: A. P. Number: Address: Legal Description: City, ST, Zip: Contractor: r: Address: D TeleP hone: ptJ 3 � 0 Project Description: City, ST, Zip: ne• TeleP ho . State Lie. # : City Lie. Arch., Engr., Designer: A T C L_ or •. Qv �•j-q Address: �%(OO • /�1 l0 City, , STZi P: �. Telephone: ne: :on Pe: Occupancy:an CstruttionTY cY State Lie. # Pr . oJectty P circle one): New Add'nAlter Repair. Demo. Name of Contact Person: Sq. Ft.: #Stories: #Units: Telephone # of Contact Person: Estimated 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, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance. Tit!e 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical . SubcontactorList Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN IiOUSE:- 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 I'crmit Fees STATE OF CALIFORNIA ' RESIDENTIAL ALTERATIONS CEC-CFIR-ALT-01-E Revised 06/14 CERTIFICATE OF COMPLIANCE Prescriptive Residential Alterations = Project Name: •CALIFORNIA ENERGY COMMISSION ' CF1R-ALT-01-E _ (Pagel of 4). Date Prepared: A. GENERAL INFORMATIOJV 01 02 01 Project Name: 02 Date Prepared: 03 Project Location: —17 04 Building Front drig6iation (deg or cardinal): 05 CA City: 06 Number of AliRr,0 vvelling Units: Qr 07 Zip Code: 08 Fuel Type. 09 Climate Zone: � 'S 10 y �r T,ota•,hConditioned FlooryAf�a (ft2)-)'= - • 11-12 Type 12 SiabArea (ft2) AVIO' 13 Project Scope: _. f V 14, 41k Zwl W .,IV B. BUILDING INSULATION DETAILS (Section_150.2(b)1)4.4 01 02 03 04 05 06 >,„k'' 07 08*. X09 10 _ ' 11leu Tag/ID ' Assembly Type Frame Type Frame Depth (inches) Frame Spacing I (inches) Aft 1* Pro o'ieRequired Method of Comments Gon* vAppendix JA4 kc Reference Cavity insulation R -value Rvalue; U•-fagtor Table, Cell I Ll -Factor _I rprqduct Deck 'Initial Solar • Aged Solar :Thermal SRI Aged Solar Thermal 'SRI Compliance Pitch OLP -. W e Number , Type" lnsula.tion Reflectance Reflectance Emittance (Optional) Reflectance Emittance (Optional) f r"111100 Mr W -P C. ROOF REPLACEMENT (Prescriptive Alteration; Sectn150.2(b)1H) - Ol 02 03 0405 ,, 06 - Y0.7� 08 09 10 11 12 13 R-vaIue +�It 9` Proposed Minimum Required Method of Roof - CRRC.Prroo ct ID rprqduct Deck 'Initial Solar • Aged Solar :Thermal SRI Aged Solar Thermal 'SRI Compliance Pitch Exception Number , Type" lnsula.tion Reflectance Reflectance Emittance (Optional) Reflectance Emittance (Optional) f . s ` _ NOTES + . .. • Roof area covered by biding integrated photo ap�nels and solar therm panels are exempt from the above Cool Roof requirements:' h�mstallati from • Liquid field appliedoatmgmust comply wit n.c iter ria -section 110.8(1)4:. A. Registration Number: Registration Date/Time: HERS Provider: CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014 STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CERTIFICATE OF COMPLIANCE CFIR-ALT-01-E Prescriptive Residential Alterations (Paee 4 of 4) I Prosect Name.,-K,`oo�,-', —•a o a .Q_ I Date Prepared: 01 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT —V 1. 1 certify that this Certificate of Compliance documentation is accurate and complete # �� Documentation Author Name: i Documentation Author Signature:] Company: t Signature Date: Address: CEA/ HERS Certification Ideffificatioflif applicable):. %"S1 City/State/Zip: Phone: 4 J RESPONSIBLE PERSON'S DECLARATION STATEMENT I certify the following under penalty of perjury, under the laws of the State of California1. The information Certificate Compliance is provided on this of true and correct.2. ®r. I am eligible under Division 3 of the Business and Professions Code to accept respons'bilitty;for the buildinge`siystem design identified on this Certificate of Compliance (responsible designer). \J 3. That the energy features and performance specifications, materials, components}end manufact r�ed� evices for the building design or system design identified on this Certificate of .r a Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California C�de ofi3egulations. witrthtllie 4. The building design features or system design features identified on this Certificate of CO-Ri dance are consistent information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to th0hforcement agerlcyfo approval with th's u.11.ding permit application. t-hks 5. 1 will ensure that a registered copy of this Certificate of Compliance:shall be madeavailable with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificateof Compliance is r�e`qred'to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer Name: ReSDo�sible Designer Signature: Company: f% © Date Signed: Address: J� {ti �✓�t License: City/State/Zip: � �"—"` - Phone: 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 12/00/16 66:36:50 (925) 659-8192 -> OUR,, I's-114tki 9800 Fredericksbur1 g Road A San Antonio, Texas 78288 USAA� To: to whom it may ,conern Fax 760-777-7011 From.- Patterson, Kim (PLL0205) (210) Fax Messages: Date and time of transmission:Thursday, December 08, 2016 8:36:02 AM Number of pages inchtding this cover sheet: 05 CONFIDENTIALITY NOTICE: The information contained in this facsimile transmission is CONFIDENTIAL and may be protected by one or more legal privileges. It is intended solely for the use of the addressee identified above. If you are not the intended recipient, you are hereby notified that reading, copying, disclosing; or distributing this transmission is STRICTLY PROHIBITED. The sender does not waive and has not waived any applicable privilege by sending the accompanying transmission. If you have received this transmission in error, please,notify the sender immediately by telephone, and we will arrange to have the transmission returned to the sender at no cost to you: Thank You. 12/08/16 66:37:10 (925) 659-8192 -> AT&T/USAA Page 802 PAGE 1 ` .MAIL MACH -1 59787 1 12/08/16 USAA® HOMEOWNERS POLICY PACKET EFFECTIVE: 12-08-16 TO: 05-20-17 ARTHUR L FREASE 14025 SW MCCABE CHAPEL RD MCMINNVILLE OR 97128-8517 GIC 03826 04 95 90A IMPORTANT MESSAGES Refer to your Declarations Page and endorsements to'verify that coverages, limits, deductibles and other policy details are correct and meet your insurance needs. Required information forms are also enclosed for your review. 1) Go to usaa.com to view policy coverages and home features. This isnot a bill. Any premium charge or return for this•policy will be•reflected on your next regular monthly statement. To receive this document and others electronically or view your policy summary online, go. to usaa:com. ' For U.S. Calls: Policy Service (800) 531-8111. Claims (800)!531-8222. HOCS1 49709-0406 :12/88/16 86:37:31 (925) 659-6192 -> ATMUSAA Page 683 PPCF 2 THIS PAGE INTENTIONALLY LEFT BLANK f 12/00/16 06;37:42 (9Z5) 659-0192 -> OMEN Page 894 PAGE 3 _ R USAA GENERAL INDEMNITY COMPANY MAIL MACH -1 `® 9800 Fredericksburg Road - San Antonio, Texas 78288 USAA AMENDED DECLARATIONS PAGE - EFFECTIVE 12/08/16 Named Insured and Residence Premises Policy Number ARTHUR L FREASE AND LILLIAN E FREASE GIC 03 826 04 95 90A 54020 AVENIDA VELASCO LA QUINTA, RIVERSIDE, CA 92253-3687 0 Policy Period From: 05/20/16 1 To: 05/20/17 (12:01 A.M. standard time at location of the residence Dremises) SECTION I - COVERAGES AND AMOUNTS OF INSURANCE COVERAGE A —DWELLING PROTECTION $246,000 COVERAGE B - OTHER STRUCTURES PROTECTION $24,600. COVERAGE C - PERSONAL PROPERTY PROTECTION $184,500 COVERAGE D - LOSS OF USE PROTECTION(UP•TO 12 MONTHS) $49,200 .SECTION 11 - COVERAGES AND LIMITS OF LIABILITY Personal Liability — Each Occurrence $3 0 o , oo o Medical Payments to Others, $5,000 ,DEDUCTIBLES (Applies to SECTION 1 Coverages ONLY) We cover only that part of the loss over the deductible stated. ALL PERILS $1,000 POLICY PREMIUM fo.r Section Land Section 11 Coverages Above $603.63 CREDITS AND DISCOUNTS (Included in policy premium above.) $101.45 CR Details on the following page. (If applicable) OTHER COVERAGES AND ENDORSEMENTS Forms and Endorsements are printed on the following page. STATE SURCHARGES AND TAXES (Shown below if applicable) TO TA:L: P O'L I C Y:::P;R EIUI I U M::::::::::..........:::......:::;';:::::::::'::::::::'::::'::'::::;:`::; ;::Including Credits ;D�scounts 0 tonal[ :Covera es;::ndorsements, S#ate: Sur:char 'es: and Taxes'::' "` `? ': g ...:..:.;:.:.:.::........ .: :.:..:.:.;. :.:.:.:.:.::.::;:..::. ;:.:.:..:.:.:.:.:.;.:.:.:.::.:::.......: : „ TOTAL PRORATED RETURN $4.59 PREMIUM DUE AT INCEPTION. THIS IS NOT A BILL. STATEMENT TO FOLLOW. In witness whereof, this policy is Signed on 12/0�j7/16� i Deneen Donnley, Secretary S. Wayne Peacock, President REFER TO YOUR POLICY FOR OTHER COVERAGES, LIMITS AND EXCLUSIONS. HO -D1 (07-08) ATTACH THIS DECLARATION TO PREVIOUS POLICY 87028-0708 1Z/08/16 06:38:19 (925) 659-9192 -> AT&T/USAA. Paye 095 LAST PAGE 4 USAA GENERAL INDEMNITY COMPANY usAW AMENDED DECLARATIONS PAGE - EFFECTIVE 12/08/16- Policy Number Policy Term: '05/20/16 05/20/17 GIC 03826 04 95 90A Inception Expiration r POLICY AND ENDORSEMENTS. THAT ARE PART OF•YOUR CONTRACT WITH US. - REMAIN IN EFFECT (Refer to prior Policy Packet(s) for documents not attached.): QRN I C (07-08) QUICK REFERENCE -SPECIAL {FORM -HO-3R(02) (07-08) HOMEOWNERS SPECIAL FORM HO -ACP (07-12) AMENDMENT TO CONTRACT PROVISIONS HO -CA (04-14) CALIFORNIA SPECIAL PROVISIONS HO-SLS3CA (07-08) SPECIAL LOSS SETTLEMENT HO -125 (07-08) HOME PROTECTOR HO -208 (07-12)' WATER BACKUP OR SUMP PUMP OVERFLOW H_0-728 (07-12) REPLACEMENT COST COVERAGE HO-90CA (07-08) CALIFORNIA WORKERS COMPENSATION YOUR PREMIUM HAS BEEN REDUCED BY THE FOLLOWING CREDITS AND DISCOUNTS: AUTO AND HOME COMBINATION DISCOUNT $67.07 CR HOME AGE DISCOUNT $34.38 CR REASON (S) FOR CHANGE: CHANGE DWELLING LIMIT OTHER STRUCTURES LIMIT UNSCHEDULED PERSONAL PROPERTY -LIMIT ADDITIONAL LIVING EXPENSE LIMIT HO -D2 (07-08) 12/07/16 87029-0708 a�ll'�cv BUILDING'&'SAFETY DEPARTMENT 78-495 CALLS TAMPICo (760) 777-7012 LA QUINTA, CALIFORNIA 92253 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! 1 Hiring a California Licensed Contractor means you do not personally perform any of the construction work, the permit'is not taken 7 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. Benefii/Risk: Hiehest 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 tum to serious financial risk if you hire unlicensed contractors to perform any of the work- Benefit/Risk: orkBenefit/Risk: Possible Benefit and Siznifrcant Financial Risk wner-as-Employer is a type of.Owner-'Builder where you pay any unlicensed individual to perform any construction work valued at ~ more than $500.00, the permit is taken .out in your name and you are. personally responsible for their employment requirements, supervision, performance, safety and welfare while on your property. WARNING: Cost savings benefit can tum'to serious financial . risk if you fail to deduct payroll taxes or provide workers compensation insurance for each worker. Bene it/Risk: Possible Benefit with Significant 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 contractor: - Licensing requirements • Employers tax liabilities % Over 20,000 consumer complaints are filed each year. Many complaints relate to owner/builder projects i,C and include workmanship and workers' compensation issues Homeowners suffer financial harm due to U . defective workmanship and injured employees. Following are alarming examples of what has occurred with Owner -Builder permits: •�kExample 1: Homeowner received insurance money to rebuild burned -down home. ■ Owner/Builder permit pulled to rebuild structure. Unlicensed contractor built subs_andard 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. kDid 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? N id you know — your homeowner's insurance may not provide coverage for injuries sustained on your roperty 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"? �id'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 . T d- . f 4 4.,a�rw P:•O. Box. 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760)777-7012 FAX (760) 777-7011 Disclosures &Forms for Owner -Builders Applying for'Construction Permits IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building peftnit has been submitted in y9pr name listing yourself as the builder of the property improvements specified at .64/ j� We are providing you with an O cTr-Bui)der Acknom4edgment and Information Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We Will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signer you understand or verify this information. I- I understand,a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" jl 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 truction and are not hiring a licensed Contractor to assume this responsibility. tk3. 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. f4. I understand Contractors are required by law to be licensed'and bonded in California and to list their license numbers on p'erm�its and contracts. �5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value oy construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "e 1 " under state and federal law. Y oyer r&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/ I 17. understand under California Contractors' State License Law an Owner -Builder who builds single.- farruly residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed bylicensed 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. Ids 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 Ufinancial or personal injuries sustained by .any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 622 9. I understand I may obtain more infarmation 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. 0. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the partyd egally , and financial responsible for ioposA construction activity at the following address: • 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 againstunlicensed 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 verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Signature of Date: /,;7-- 9' — 2m/(. Note: ae 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 the permit is issued to verify thepropertyowners signature. Property Owner's Signature: Date: