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13-1442 (DEMO)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: 13-00001442 78725 AVENIDA LA FONDA 770-171-006-149 -000000- DEMO - COMML/OTHER LOW DENSITY RESIDENTIAL 100 Architect or Engineer: 4.4 Qg(k& BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: PHILLIP & ROSSIE GUTIERREZ 78725 AVENIDA LA FO LA QUINTA, CA 922539 ( � 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 Professionals Code, and my License is in full force and effect. Li ass: License No.: Date: Coractor: 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 tfa,'plp�liclml rshe is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by fora permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).: 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 novintended 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.). �1 1 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: L 1 — \ Owner: CONSTR CTION 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: LQPERMIT Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/13/13 NOV 14 2013 D OF � QUIM ATAT 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: 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: Applicant: 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 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 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 t ' county to enter upon t above-mentioned prop ty for inspection purposes. Date:. Signature (Applicant or A Application Number . . . . . 13-00001442 Structure Information Construction Type . . . . . TYPE V, UNPROTECTED Occupancy Type . . . . . . DWELLG/LODGING/CONG <=10 ---------------------------------------------------------------------------- Permit . . . DEMO PERMIT Additional desc . Permit Fee 35.75 Plan Check Fee .00 Issue.Date . . . . Valuation . . . . 100 Expiration Date 5/12/14 Qty Unit Charge Per Extension 1.00 35.7500 LS MISC DEMOLITION, EXT 35.75 ---------------------------------------------------------------------------- Special Notes and Comments DEMO - DEMO UNPERMITTED 20FT. X-15FT. PORCH AND 4FT. X 5FT. WASHROOMS. RE-ROUTE DETACHED WORKSHOP ELECTRICAL TO UNIT #1. 2010 CALIFORNIA BUILDING CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . PLAN CHECK, DEMOLITION 107.25 Fee summary Charged Paid Credited ------------------------------ Due --------------------------- Permit Fee Total 35.75 .00 .00 35.75 Plan Check Total .00 .00 .00 .00 Other Fee'Total 107.25 .00 .00 107.25 Grand Total 143.00 .00 .00 143.00 C LQPERMIT 1 Bin # Qty of La Quinta Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: l g'12 et A'd v o a4. Owner's Name: A. P. Number: Address: Pv1 F7 Legal Description: LO K,,.k-At— v- City, ST, Zip: ' v-,,- Contractor: Telephone: Address: Project Description: MD of C.k 70 A I City, ST, Zip: of Telephone: %:"�'<. �:?:^ver"<:,::. • State Lic. # : ON Lic. #;F, Arch., Engr., Designer: Address: IF City., ST, Zip: Telephone "''"'` '" State Lic. #• �%::y'>:'ss<f�;�:r.�:<=M:<:>'s>;>:�;::r.;:s::.:;•:.y: +,.,;:-:::c <h.;>:,«<•+ {L2C:yrr i i::.`fv •i... .. - Name of Contact Person: ���j l % t {1/i! Z Construction T e: Occupancy: , Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: #Units: Telephone # of Contact Person: Gtr — fj` Estimated Value of Project: 10 Q APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 21" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person • A•I•P,P, Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees 1 S -1 0-1 2 S . i, -,A �F o P D� �v�t��� U. -A �o �' .--C ITY_OF LA CSU I.NTA BUILDING & SAFETY DEPT. APPROVED FO/R O STRUCTION ~ DATBY- 4 P.O. BOX 1504 'LA QUINTAI* CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT 78-495 CALLS TAMPIC0. (760J .777-7012 LA.QUINTA, CALIFORNIA 92253 FAX.(760) .777-7011 PROPERTY OWNER'S PACKAGE , Dhclo'sures'& Formiiis for Owner-'BuHders Appiylingfor Consiruidlo T erinits LWOATANV. MICE TQ T FERTY-OWNER DearTrWerty Owner AW application y for -a - building Permit - has witted in name, HSI, yourself, as the builder of the.property LnIpEovemetits specified at '72 c; L—ce A�—d Q k -k "'0, We are: Providing you with an Owner -Build" Acknowledgment -and Information;of your fication-Forin.-to make YOU aware respomibi)ities'and;Pow.blerisk -y- ued.in YW*. f ria ,.a as tht Owneir-Builder. W ut;wilt not ism�a budding -permit until,,�ou -have read; initialed your. understanding of each'provision, signed, and returned this form to us at our official address indicated. An agent of thtiowner cannot. execute -this. notice unless you, the Property owner, obtain the prior approval of the permitting authority. DIRE: ORead On. L 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 or her own labor and material pe"mon"ally. 1, 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 - c Q1 understand building permits are not required to be signed by property owners. unless they are responsible for the ction and are not ".,a, licensedContractor. to assume this resporisibitity- i I undertland, as. an."Owner-Builder" i , I am the responsible party of.re'6orid on the per;fi'iL I understand That I may protect L Y If from potential ial financial risk by hiring a licensed Contractor and having the permit filed in hisor &r, name instead of my SIC 4k4. I understand Contractors are required by taw to be licensed and bonded in California and to list their license numbers on permits and contracts. f-5. I understand if I employ or otherwise engage any per sons, 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*pr9yide workers' compensation disabilityinsurance, 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*. 1 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. _8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable, for any financial or personal. 4uries sustained by any subsequent owners) 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 "employer" from the Intimal 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 (CSLI) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. �10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and, financially responsible .for proposed construction activity at the following address: 11. I agree that, as the party legally and fmancially responsible for this proposed construction activity, I will abide by all app cable laws and requirements that govern Owner -Builders as well at employers. ,a_ 12.1 agree to notify the issuer of this. form immediately of any additions; deletions, or changes to any -of the information I ve 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 LicenseBoard may be unable tofiftalwial you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in�civd court_ It is also important for you to: understand that if an unlicensed Contractor or employee of that individual or firm is injured while worldng on your property; you Mile be l_eld. l &W, for damages. If.you obtair= a permit as Owner -Builder and wish to him Contractors, you wdl be responsible for verifying whether or not those Coutractors are properly licensed and the status of their wotkers' compensation inwranoe 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 issaing,&e..per tL Note: A copy of Ste property owner's Myers liwe farm irota baa; or other verification acceptable to the agency is required to be'presented when the permit is inwJ to verify the property owner's signature. Signature of property owner Date: Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand. is my personal responsibility, I hereby authorize -the followirig 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 owner's signature.. Property Owner's Signature : -Date: Tjt�p 4 4a" P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA,92253 - BUILDING & SAFETY DEPARTMENT (760) 777-7012 - - ,.-, FAX (7,60) 777-7011 Considering Becoming an Owner -Builder? STj 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 i ..your name, you are not personally responsible for the construction and you are not an Owner -Builder. Instead, you become a _. - "Cu to-m- er" and California law provides you the benefit of protection from poor workmanship. failure to finish the job and financial risk;iva to worker injury. B.enefit/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 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-Cantractor 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 tam to serious financial risk if you hire unlicensed contractors to perform any of the work. BenefitMsk: Possible Benefie and Significant Financial Risk Owner -as -Employer is a type of Owner -Builder where you pay any unlicensed individual to perform ani, 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: Pussible Bericl'tt 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 'contractors - Licensing requirements - Employers tax liabilities 1 Over 20,000 consumer complaints are filed each year. Many complaints relate to ownerlbuilder 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 filed an exemption from Workers Comp. • Owner -Builder hires brother-in-law to install a new roof. ■ Employee falls and sustains multiple spinal and extremity fractures as well as a head injury and remains in a coma to this day. - The Owner -Builder, who has sold the home, is now a defendant in a lawsuit for reimbursement for benefits paid to the injured worker. Example 3: Employee of contractor without Workers Comp is hired by Owner -Builder to install septic system and suffers injury that results in permanent disability. • The Owner -Builder did not have a homeowner's insurance policy on the house against which to submit a claim. ■ The Owner -Builder is now a defendant in a lawsuit for reimbursement for benefits paid to the injured, worker. Did you know — unlicensed persons frequently have the property owner obtain an "Owner -Builder" building permit which erroneously implies that the property owner is providing his or ; er owns labor a. �d 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