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BELC2016-00797 78-495.CALLE TAMPICO, LA gUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT' Application Number: BELC2016-0079 Property Address: 77670 CALLE SINALOA APN: 773133023 Application Description: FREDERICKS / CHANGE OUT MAIN BREAKER Property Zoning: Application Valuation: $100.00 Applicant: OWNER BUILDER -------------------------------------------- --- LICENSED CONTRACTOR'S DECLARATION - I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: License No:: o — Date: �— �� 2� o Contractor: r�yG 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 fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: �) I, 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: 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 Lender's I VOICE (760) 777-7125, 'FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/12/2016. Owner: JEFF FREDERIC_KS _ !; 28 10TH CT . t -- a, HERMOSA BEACH, CA 92253 II rq C -cc• c� < u, Contractor: OWNER BUILDER'< Q t� U 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 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: Conoteirriploy Policy Number: _ I certify that in the performance of the work for which this permit is issued, I sh 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 Labor Code, I shall forthwith comply with those provisions. Date: Applicant: WARNING: FAILURE TO SECURE WORKS NZALTIES CO COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN'EMPLOYER TO CRIMINAL PE 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 cif, 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. n n Date: 7-7-0 /� Signature (Applicant or Agent) Date: 9/12/2016 Application Number: BELC2016-0079 Owner: Property Address: 77670 CALLE SINALOA_ JEFF FREDERICKS 'AW: 773133023 28 10TH CT Application Description: FREDERICKS / CHANGE OUT MAIN BREAKER HERMOSA BEACH; CA 92253 Property Zoning: Application Valuation: $100.00 Applicant: Contractor: OWNER BUILDER OWNER BUILDER LIc. No.: Detail: CHANGE OUT MAIN BREAKER. 2013 CALIFORNIA BUILDING CODES. i BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT OTHER ELECTRICAL EQUIPMENT .101-0000-42403 .0 $24.17 DESCRIPTION ACCOUNT QTY AMOUNT OTHER ELECTRICAL EQUIPMENT PC 101-0000-42600 0 .$24.17 Total Paid for ELECTRICAL: $48.34 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $91.85 TGtal-Pai'd'for PERMIT ISSUANCE:' $91.85 TOTALS: $141.19 • a c i y I BUILDING & SAFETY DEPARTMENT 78-495 CALLS TAMPICO (760) 777-7012 .LA QUrNTA, CALIFORNIA 92253 FAX (760) 777=7011 Considering Becoming an Owner -Builder? Important information you need to know BEFOREpulling 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 anOwner-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: 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 Lova 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 Significant 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/Riski Possible Benefit with Significant Financial Risk r I BUILDING & SAFETY DEPARTMENT 78-495 CALLS TAMPICO (760) 777-7012 .LA QUrNTA, CALIFORNIA 92253 FAX (760) 777=7011 Considering Becoming an Owner -Builder? Important information you need to know BEFOREpulling 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 anOwner-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: 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 Lova 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 Significant 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/Riski 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 propertyas 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 -a -head injuryand 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 injuredworker. 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 homeowners 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 herown 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 . 3 P.O. Box 1504 . 'LA QUINTA, CALIFORNIA 92247-150'4 BUILDING & SAFETY DEPARTMENT - 78 -495 CALLE TAMP.ICO (760) 777-7012 `i LA. QUINTA, CALIFORNIA,92253 'FAX (760) 777-7011 PROPERTY.. OWNER'S PACKAGE,', ' - 'Disclosures & Forms -for Owner=Builders Applying for Construction Permits IMPORTANT!NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building •pe mit*has been submitted.in yournaame 1; istmg6yo_urselfTasTthelbuilder of the property improvements specified at ��ly%4 C��%¢,Sj��ot • ,� Weare providing you with —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.atour official address indicated. An agent of the owner cannot execute -this notice. unless you, the property owner, obtain the pnor approval of the permitting•authority: R OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signify you understand or verify this information.. ` i . I understand a frequent, practice of. unlicensed persons is to have the •properly owner obtain`an "Owner -Builder" f YEtilding 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 iiable and•subject to serious financial risk for any injuries sustained by, an unlicensed person andhis or her employees while working on my _property.'My homeowner's insurance may not provide coverage for those f injes. I am willfully acting as an Owner -Builder and am aware'of the limits of my insurance coverage foi injuries to workers on,my property' g2.` I understand buil rmits are not r y ding pe required to be signed'•by property owners unless they are responsible for .the ction and are not hiring a licensed Contractor to assume this responsibility, y Aeol . I understand as an"Owner-Builder" I am there nsible ' spo party of record on the permit. I understand that I may protect . f from potential financial risk.by hiring a licensed Contractor and having the permit filed in'his or her name instead of my own Ae� I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on and contracts. ^ A ..I understand.if I e to or otherwise en a e an ' mP Y g g . y persons, other than California licensed Contractors, and the total valuey construction is at least five'hundred dollars ($500), including labor and materials, I may be considered an "employer" under 'state and federal law. � AMC, 6. I understand if I am consideied an'"e lo' er', under state and federal law mp Y , I must register with the state and federalment, withhold payroll taxes, provide workers' compensation disability insurance- and contribute to uriemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to.serious financial risk. , s cyI understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential es cannot legally build them with the . intent to offer them for sale, unless all work is performed by licensed �subcontractors and the number of structures does not exceed four within any calendar year, or .all of the work is performed under contract with a licensed general building Contractor: ' V 8. Lunderstand as,an Owner -Builder if I sell the property for which this permit is issued,.I may be held liable for any ' t ancial or personal injuries 'sustained by any subsequent owner(s)`that result from any latent construction defects in the workmanship or materials. , _ " r 9. I understand I may obtain more information regarding my obligationsas an."employer" from the Internal Revenue . ervice,'the United States Small -Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the Califomia Contractors' State License Board (CSLB) at 1- 8400+32.1-CSL9 (2752) or www.cslb.ca.gov for more information about licensed contractors. 410. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the a$rt legally : and financially responsible ' for ` proposed construction activit. at ,the following address: 7 r 7 -•�'+'. , is v. 4 _� 11. I wee that as the ' Br party legally and financially responsible for this proposed construction activity, I'will abide.by all . ppicable 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 , Iave' provided on this form Licensed contractors are regulated by laws designed to protect the .public. If you contract with Som one who does not have a license, the Contractors' State License Board may be unable -6 assist you with any financial loss you may sustain as a result of a complaint Your only'remedy against unlicensed Contractors miy be in civil cow. -it i' 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: , -B hfo'tre a building permit can be'issued, this form must be'completed-and signed by the property owner and r�urned to the agency responsible for.issuing the, permit Note:.A copy of the property owner's driver's license, form notarividon or othe�. verification acceptable to the.agenty is required -to be presented when the permit is issued to verify'the.prope�ty . owner's signature. c. S* t& proPerh': ovine �- Date '�� — 2!J//� r ~_ 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 fora 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 , r Permit for my project. - Scope of Construction Project (or Descriptionof Work): ` Project Location or Address: , Name of Authorized Agent: Tel No' Address of Authoriied Agent: , Tdeclare under penalti 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. 6mier's'driver's license, form notarization, or other verification acceptable to the agency is required to be presented ivheri the permit is issued toverify'the property owners signature. Property Owner's Signature: Date: Bin # Permit #; troJect Address: . � r` y �f U Iiia Building a Safety Division 78-495 Calle Tampico La Quinta, CA 92253 -,(760) 777-7012 Building Permit Application and Tracking Sheet - �O�ti mer, "s Tgamc: G 4 a-nc A. P. Number: Ad'dres"s: RftR Legal Description:ST; Zips, s nr Contractor: 0 r: L A� T� - - ' n- Tele ho e: _P 1 Address:�Prcject Description; 1, City, ST, Zip: Telephone: one: State Lic. # : City,Lic. Arch., Er gr., Designer: - s Address: City, ST, Zip: Telephone: • .n CoC tructi n TYP e: O ecu aney ,. � S tater Lic. # Project nP 'Add'n Alter Repair.air De 0a �circle one : New m fName.of-'C—ontac'erson: Sq. Ft.: # Stories: # Units: Tele hone # o, Contact.Eer oa a .a, P _ �_Estiniated r Value.of.Lroject Da APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rcc'd -TRACKING PERMIT FEES Plan Sets Plan Check submitted Item A nt Structural Calcs. Reviewed; ready for,corrections Plan Check Deposit ' Truss Calcs, Called Contact Person Plan Check B ce. Title 24 Cates. Plans picked upC ruction Flood plain plan Plans resubmitted _A'lMcchanical Grading plan 2'd Revicw, ready for corrections/is Electrical Subcontact'or List. 'Called Contact Person Plumbing Grant Deed ' Plans picked S•M.1. i ' H.O.A. Approval Pl esubmittcd Grading r IN 11OUSE:- '`d. Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. 1\'ks. Appr Date of permit issue School Fees, Total Permit Fr—' i