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BRER2014-1025C� Q� � .VOICE (760) 777-7125 78-495 CALLE TA`I' ICO U FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 10/20/2014. Application Number: BRER2014-1025 D �'z1 ` Owner: Property Address: 52885 AVENIDA VILLA LUIS MOLINA APN: 773333021 ' OCT 2 0 2014 Application Description: REROOF 92253 Property Zoning: CITY OF LA ,Application Valuation: $6,000.00 COMMUNITY DEVELOPMENT DEPARTMENT } Applicant: Contractor: LUIS MOLINA ` ,•92253 ` Llc. No.: LICENSED CONTRACTOR'S DECLARATION . WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penalty of perjury•one of the following declarations: 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, I have and will maintain a certificate of consent to self -insure for workers' and my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance - License Class: _ License No.: _ of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Date: Contractor: \ 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: OWNER -BUILDER DECLARATION Carrier: _ Policy Number: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State I certify that in the performance of the work for which this permit is issued, I License Law for the following reason (Sec. 7031:5, Business and Professions Code: Any shall not employ any person in any manner so is to become subject to the workers' city or county that requires a permit to construct, alter, improve, demolish; or repair compensation laws of California, and agree that, if I should become subject to the any structure, prior to its issuance, also requires the applicant for the permit to file a workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith signed statement that he or she is licensed pursuant to the provisions of the comply with those provisions. 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 Date: Applicant: basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, ($500).: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO (_) I, as owner of the property, or my employees with wages as their sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF compensation, will do the work, and the structure is not intended or offered for sale. COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES. 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 APPLICANT ACKNOWLEDGEMENT ' are not intended or offered for sale. If, however, the building or improvement is sold IMPORTANT: Application is hereby made to the Building Official for a permit subject to within one year of completion, the owner -builder will have the burden of proving that the conditions and restrictions set forth on this application. he or she did not build or improve for the purpose of sale.). 1. Each person upon whose behalf this application is made, each person at whose (_) 1, as owner of the property, am exclusively contracting with licensed contractors request and for whose benefit work is performed under or pursuant to any permit to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' issued as a result of this application , the owner, and the applicant,' each agrees to, and State License Law does not apply to an owner of property who builds or improves shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and thereon, and who contracts for the projects with a contractor(s) licensed pursuant to employees for any act or omission related to the work being performed under or the Contractors' State License Law.). following issuance of this permit. (� I am exempt under Sec.' B.&P.C. for this reason 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. - Date: Owner. I certify that I have read this application and state that the above information is correct. CONSTRUCTION LENDING AGENCY I agree to comply with all city and county ordinances and state laws relating to building I hereby affirm under penalty of perjury that there is a construction lending agency for construction, and hereby authorize representatives of this city to enter upon the above - the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). mentioned property for inspection purposes. Lender's Name: Dat ' Lo Signature (Applicant or Agen Lender's Address: FINANCIAL INFORMATION UNT AMOUNWCRIPTION ACCOYPAID PAID DATE' , �, a;x BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 10/20/14 PAID BYE METHODti��` -z RECEIPT #7;?�, CHECK # CLTD BY' _ ... LUIS MOLINA DEBIT R2206 MFA Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $1.00 ;DESCRIPTIONJU'.°' �`"3 QT1(,QMOUNT#, PAIDti¢' PAID DATE' 3 sACCOUNT RE -ROOF - FIRST 2,000 SF 101-0000-42404 0 $49.31 $49.31 10/20/14 PAID BY ` � ��� METHOD Z s u z�.'RECEIPT# ,r x. CHECKZt, # CLTD BY LUIS MOLINA DEBIT r R2206 MFA z r < DESCRIPTION° ACCOUN QTY`' "� AMOUNTtiA. PAID DATE, _ TT jPAID RE -ROOF - FIRST 2,000 SF PC 101-0000-42600 0 $98.62 $98.62 10/20/14 3�y PAID;BY�:s METHODS *RECEIPT# CHECK # « meq., CLTD Bllz ��fkg_: &; _'s ., t E ,. LUIS MOLINA DEBIT R2206 MFA Total Paid for RE -ROOF: $147.93 $147.93 TOTALS:4. Description: REROOF Type: RE -ROOF Subtype: 3 Status: SUBMITTED Applied: 10/20/2014 MFA Approved: Parcel No: 773333021 Site Address: 52885 AVENIDA VILLA LA QUINTACA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 147 , Lot: 8 Issued: UNIT 15 Lot Scl Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $5,000.00 • Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: LOW E THEMA SHEET W/GAF TIMB NS SHAKEWOOD ROOFING PER 2013 CALIFORNIA ENERGY CODE ADDITIONAL SITES . ......... . Printed: Monday, October 20, 2014 4:14:59 PM 1 of 2 "DESCRIPTION ;` -s'` rig ? ' A000UNT _ CITY x �_ .. lr AMOUNT �.« •:zi ^z '"g"y >r.. 4_ =PAID x. , rt PAID DATE ., ,. ";RECEIPT # s_gY: sem .f > " CHECK # .:.,k y METHOD ^` - 4 .. PAID BY. "r '. - s J.CLTD.; - RE -ROOF -FIRST 2,000 101-0000-42600 0 $98.62 $98.62 10/20/14 R2206 DEBIT LUIS MOLINA MFA SF PC Total Paid for RE -ROOF: $147.93 $147.93 TOTALS: $148.93 $148.93 INSPECTOR , ;SCHEDULED „ ` � NOTE 'INSPECTION r n d t DATE : DATE' 1 r> , r FINAL" PRE -ROOF BOND INFORMATION .. ATTA/^I AA Ar ft C . • ., ,- .. a .4 - . . ; + .. r'i. ,� . ..r ' — \ . ," Printed: Monday, October 20, 2014 4:14:59 PM 2 of 2 Bin # City of La Quinta Building &r Safety Division 04. P.O. Box 1504, 78-495 Calle Tampico La Quinta, "CA 92253 - (760) 777-7012 ' Building Permit Application and Tracking Sheet Permit.# Project Address: Owner's Name: M01 1' h A. P. Number: Address: 8� V n iGrGt Legal. Description: City, ST, Zip: U 1 y� co •Z 5 Contractor: or: c hn•(] T le e.. P 0 Address: r Project.Description: �Q,P,00{Ivt City, ST, Zip: —+ Telephone: • State Lic. # : City Lie. #: l Arch., Engr., Designer: Address: City., ST, Zip: Telephone: P >:::#<::<-:>:::<:.:.:!.:,:>:.>:>:>:,::: r:. Construction Type: Occupancy: State Lic. Project type circle one): New Add'n Alter Repair Demo^`:r Name of Contact Person: Sq. Ft.: , goo # Stories:# Units: Telephone #,of Contact Person: Estimated Value of Project/' QQ(� APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets PIan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check D :posit Truss Cala. Called Contact Person Plan Check Balance. Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2"" Reviav, ready for co rrections/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 correctionsfissue Developer Imfact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue Scho6lFees Total Permit Gees STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CEC-CFIR-ALT-01-E Revised 06/14 CERTIFICATE OF COMPLIANCE Prescriptive Residential Alterations Project Name: Date CHR -ALT -01-E (Page 1 of 4) A. GENERAL INFORMATION 01 ,C%I. 01 Project Name: 02 Date Prepared: ,11\& y> 03 Project Location: S Z 5K Z -T- A V E Pnb 04 Building Front_Orientat on`(deg r cardi al): 05 CA City: I—A &Llf T 06 Number of Altered, Dwelling Units: 07 Zip Code: 08Fuel Type:( ' 09 Climate Zone: 10 T,ota,I Cor<ditoned Floor Aiea (ft2)':> 11 1 Building Type 12 SIab,A is"(ft2) `\""\'o 13 1 Project Scope: _ I nN "', 11, Wk .w B. BUILDING INSULATION DETAILS (Section 150.2(b)1) �rl.05\1 01 02 03 04 05 06 ` $. 67 1 08 JXtO9 10 11 Tag/ID Assembly Type Frame Type Frame Depth (inches) Frame Spacing (inches) 1'NP, cd �10, � Required Comments �t5ontinuous Cavity Insulation R -value R -value, factor� ppendix JA4 Reference U -Factor Table: Cell ~ � s N\M11# ea covered by buildingli te�grateokAale,panels and solar thermal panels are exempt from the above Cool Roof requirements. ield applieda t kgs -must tallation criteria from se i 4. A 4% A—\N V N- F W V -.& t%. I -A REPLACEMENT (Prescriptive Alteration, S rr'on%150.2(b)1HkA AXNE 02 03 04 ` 05\ \& 44 06 t�('67;e 08 09 10 11 12 1 13 if :e Roof Pitch Exception o CRRCduct ID rNumber ,Product Type . R value Deck-- , Insulation Proposed Minimum Required Xlnitial Solar Aged Solar Thermal SRI Reflectance Reflectance Emittance (Optional) Aged Solar Thermal SRI Reflectance Emittance (Optional) ~ � s N\M11# ea covered by buildingli te�grateokAale,panels and solar thermal panels are exempt from the above Cool Roof requirements. ield applieda t kgs -must tallation criteria from se i 4. A l ` �6 � L.- eoc' S 7 , T, s je�x C ��.d,����_ J� • . � 1V ation Numoer.— w--neglstration u iat�_ vr'a" V� June 2014 Ju Iding Energy Efficiency Stan ards - 2013 Resi tial Compliance ref STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CEC-CFIR-ALT-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION CERTIFICATE OF COMPLIANCE CFIR-ALT-01-E Prescriptive Residential Alterations (Page 2 of 4) Project Name: Date Prepared: D. FENESTRATION/GLAZING AREAS ALLOWED (Section 150.2(b)1) 01 02 04 03 Alteration Type Orientation Maximum Allowed ft2 Comments v 04 05 06 07 E. FENESTRATION/GLAZING PROPOSED AREAS AND EFFICIENCIES (Section 150.2(b)1) v 01 02 03 04 05 06 07 O8 AA. 09 w > j 11 1 12 13 14 15 � Combined Orientation Area Area �' 4'5 Maximum Exterior SHGC Tag/ Fenestration Frame Dynamic N, S, W, E, or Removed Added Added Allowe Shading from ID Type Type Glazing Roof ft2 ft2 Area ft2 — In factor U -factor Source SHGC Source Device CF1R-ENV-03 O ... a Net Added West facie ?enestration Area >4w b Existing + Added W t -f c ng Fenesstratian rea c Maximum A�llew dd West-facinng5 trrration Area N An d Is West -facing Fenestration Area < ax' m Allowed Wes-faccing FenestrationVsh AWat . e 4, IeVet Added FenestratreonArea (all orl�ent tion$) A,Exrsting+Adde f F.e sjration Area (all-orie`eAtat ons) g iViaxIIIluII1'AJ1yw afAe�liallunAiea(aII itntatian7) ew< h Is Existing +A''d& 'V enestration Area (Maximum Allowed Fenestration Area (all A orientations) Registration Number: - Registration Date/Time: HERS Provider: CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014 STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CEC-CFIR-ALT-01-E Revised 06/14 CERTIFICATE OF COMPLIANCE Prescriptive Residential Alterations Project Name: CFIR-ALT-01-E (Paee 3 of 41 d I Date Prepared: F. SPACE CONDITIONING(SC) SYSTEMS — HEATING/COOLING (Prescriptive section 150.2(b)) .6 Nl 01 02 03 W Dwelling Unit Name Dwelling Unit CFA (Ft2) Comnts' *, -*' 0 r G. WATER HEATING SYSTEMS (Section 150.2(b)1G) Nt Ol 02 03 04 OS 06 07 08 09> Y'10 I tl1 � 12 13 14 15 Water Heating Alteration to the Space f of Water ,(ft2% Name #. Agentiflcation or Name Conditioning System(s)? ( Back -Up * +( Water Heater System Water Water Heaters Storage Rated Rued � Heating 110 g e Exterior Solar Dwelling Unit DHW Identification or Heating Heater in Volume Fuel Input In, Efficiency Ef�fic�iennccy Standby Insul. Savings Central DHW System System Name System Type Type system (gal) Type Typpe,g Value Typed Value Loss:(%) R -Value Fraction Distribution Type Distribution Type a d �*.,p V78/ 4.It" - '%- H. SPACE CONDITIONING SYSTEMS AND WATER HEA' 1141 SYSTEMS INfMULTIFAMI%D.WWELLING UNITS �a 01 02`iq " 03 V 04�" 05 06 ~ Centra�,W.ater;Heating ( f Dwelling Unit W#ater Heating System Dwelling Unit: Dwelling UnitTotaiK§FA Sysre htification or Alteration to the Space Dwelling Unit Name ,(ft2% Name #. Agentiflcation or Name Conditioning System(s)? Comments * +( 0 Registration Number: CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: HERS Provider: June 2014 r. STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CEC-CFIR-ALT-01-E Revised 06/14 CERTIFICATE OF COMPLIANCE Prescriptive Residential Alterations Project Name: Date Pre FORNIA ENERGY COMMISSION CF1R-ALT-01-E (Page 4 of 4) DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentatioia is accurate and complete. Documentation Author Name: � p � Documentation Author Signature: t 1�10�tvta Company: Signature Date: ' . Address: 52�s 14v�enida A GEA/ HERS Certification Ideritifica(ro&0f applicable): City/State/Zip: � Phone: RESPONSIBLE PERSON'S DECLARATION STATEMENT 41, ` r I certify the following under penalty of perjury, under the laws of the State of California: AAJAII far 1. The information this Certificate Compliance is provided on of true and correct. 2. I am eligible under Division 3 the Business Professions Code to buildingd_gs'iV design identified this Certificate Compliance (responsible of and accept responsibility�for the or system on of designer). ` 3. That the energy features and performance specifications, materials, components and manufacture �e ick for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of'Regulations. 4. The building design features or system design features identified on tris'Certificate of Co"inplianceare consistentwit�i the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agenrf�oa-p roval with this building permit application. 5. I will ensure that a registered copy of this Certificate of Com�p�liahhce'shall be madess�av�aL with the buildin>� p� m t(s) issued for the building, and made available to the enforcement agency aabt4 16, for all applicable inspections. I understand that a registered eopy'of this Certificate*6� Compliance is require;`to be included with the documentation the builder provides to the building owner at occupancy. Als tew, Responsible Designer Name: , — Re's oesible Designer Signature: g VIV Company : Date Signed: Address: License: IN City/State/Zip: V9 VNBRi?: For assistance 00 estions regarding the Energy Standards, contact the Energy Hotline at: 1-80D-772-3300. Registration Number: Registration Date/Time: CA Building Energy Efficiency Standards - 2013 Residential Compliance HERS Provider: June 2014 ora S P.O. Box 1504 6i;I LA QUIN.TA, CALIFORNIA 9 2247-1 504 BUILDINC & SAFETY DEPARTMENT p4�' 78-495 CALLE TAMPICO (760) 777-7012 OF 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 thir_gs: "Owner as .Worker", "Owner as Contractor" or"O.wner as Employer" Understand each has Benefits or Risk, and it is possible to coml=-ine them! Hiring a California Licensed Contractor means you do not personally perform any of the construction work, the permit is not taken out in your name,.you are not personally responsible for the construction and you are not an Owner -Builder. Instead, you become a "Customer" and .California law provides you the benefit of protection from poor workmanship, failure to finish the job and financial risk due -to worker injury. Benefit/Risk: Highest Benefits and the Least amount of Risk Owner -as -Worker is a type of Owner -Builder where you personally perform the construction worlt, 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 b 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 turn to .erious 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/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 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 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. C � Example 3: Employee of contractor without Workers Comp is hired by Owner -Builder to install septic system and suffers injury that results in permanent disability. ■ The Owner -Builder did not have a homeowner's insurance policy on the house against which to submit a claim. • The Owner -Builder is now a defendant in a lawsuit for reimbursement for benefits paid to the injured . worker. Did you know — unlicensed persons frequently have the property owner obtain an "Owner -Builder" building permit which erroneously implies that the property owner is providing his or her own labor and material personally? Did you know — your homeowner's insurance may not provide coverage for injuries sustained on your property by an unlicensed contractor and his/her employees? Did you know — if you are considered an "employer" under state and federal law, you must register with the state and federal government, withhold payroll taxes, provide workers compensation and disability insurance and contribute to unemployment compensation for each "employee"? Did you know — that if you fail to abide by these laws you may be subjected to serious financial risk? OWNERS BEWARE AND CONSIDER THE RISK BEFORE ACCEPTING FULL RESPONSIBILITY FOR YOUR CONSTRUCTION PERMIT P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT 78-495 CALLE TAMPICO (7.60) 777-7012 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. permit has been submitte in your name listing yourself as t) a builder of the 'property improvements specified at S2",5 �_V i �fA �G Q lJ t" J -c. �o(e .97i��Gi . We are providing you with an 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 unders-anding 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 signify you understand or verify this inforrr:ation. 1. 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 wad material personally. I, as 'an Owner=Builder, may be held liable and'subject to serious financial risk for any injuries sustai'md 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 construction and are not hiring a licensed Contractor to assume this responsibility.- &3.. esponsibility.&3.. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect . myself from potential financial risk by hiring a licensed Contractor.and having the permit filed in hi; or her name instead of my own. 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. *6. 1 understand if I am considered an "employer" under state and federal .law, I must registe' 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 sub ect me to serious financial risk. A-7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for 'sale, unless all work is performed by licensed subcontractors and the number of structures doesnot exceed four within any calendar year, or aE 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 injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. Mic I understand I may obtain moreinformation regarding my obligations as an "employer" from the Internal Revenue e, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10. 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 financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. 1 1. I n n Signature of property ownerul In I �AK Date: 2=0— 1 Note: The following Authorization Form is required to be completed by. the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: Address of Authorized Agent: Tel No I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: