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BRES2015-0339. 11IO �1Nil. Bin # City of La Quin to Building &Safety Division 78-495 Calfe Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: p Owner's Name: G" i5 A. P. Number: Address:(,0 /k-7 VL Legal Description: � Zip:. - City,ST Zi A �.1 Contractor: ' 2 f� 1 Tel ehone• 3 P �Z Address: Project Description: City, ST, Zip: Telephone: f r o' State Lie. # : City Lie. #.: Arch., Gngr., Designer: Address: U City., ST, Zip: l Telephone: Contructi s on Type: O ecu ane YP Occupancy: State Lie. #• PojectJ nPa (circle one):: New Add'nAlter Re pair Demo 0 Name of Contact Person: Sq. Ft.: 17160 #Stories: # Units: Telephone # of Contact Person: w iJ V Estimated Value of Project: es O o . APPLICANT: DO NOT WRITE BELOW THIS LINE M Submittal, Req'd Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan ChpckDeposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready forcorreclions/issue Electrical Subcontactor List Called Contact.Person Plumbing Grant Deed Plans picked up S.M.I. M.O.A. Approval Plans resubmitted _. Grading IN ROUSE:- Review, ready for corrections/issue Dcvelopxr Impact Fee Planning Approval Called Contact Person A.I.P.P., Pub. Wks. Appr Date of permit issue School Fees, Total Pkrmit Fees Permit Number: BRES2015-0339 Description: MCMAHON / CONVERT SINGLE CARPORT TO GARAGE, K BATH AND STORAGE ' ,Applied: 9/1/2015 t Approved: 10/9/2015 Site Address: 53601 AVENIDA VILLA r Issued: 10/13/2015- Finaled: City, State Zip Code: LA QUINTA, CA 92253; .Status: APPROVED Applicant: ALEX TORRES Parent Permit: - Owner: CHRISTINA MCMAHON Parent Project: Contractor: OWNER/BUILDER Details: WORK STARTED WITH OUT PERMIT DOUBLE FEE WILL BE ASSESSED (CRC R108.6). SEE PICTURES IN TRAKIT FILE DATED 9/29/2015. - PERMIT INCLUDES CONVERTING EXISTING 386 SQ. FT. CARPORT TO 400 SQ. FT. GARAGE WITH P=OOL BATHROOM_ AND POOL - EQUIPMENT STORAGE AREA.. a REVISION 1: ADDING (1) SHOWER IN BATH, (1) OUTDOOR SHOWER, (1) POCKET DOOR, &'COLUMS FOR ENTRY GATE. INSPECTOR TO } VERIFY FIXTURE TRAPS. 2013 CALIFORNIA BUILDING CODES. ' $101.84 DUE TO EXTEND PERMIT TO PASS FINAL INSPECTION. ADDITIONAL FEES MAYBE REQUIEiED DEPENDENT OF RESULTS OF SITE INSPECTION BY BUILDING INSPECTOR. LIST OF • SEQ ^COMPLETED SCHEDULED DATE DATE TYPE INSPECTOR RESUL—' 'REMARKS 10/13/2015 10/13/2015 12-00 PM FOOTINGS LUIS URIBE , NOT READY ~ Notes i t � ` 4. STEELNOT COMPLETE. MISSING. EPDXY. REPORTr .+ !r 0/13/201512:00 12:00 UNDERGROUND LUIS URIBE APPROVED PM PLBG Notes. r }'PYA Y 7 4 ` 1 nr.1 • C.. 'Li 1 10/14/2015 , '; 11:00 10/14/2015 FOOTINGS LUIS URIBE APPROVED ` , AM .Notes ., 10/23/2015 10/23/2015 1P:M0FOAYTOWRAP LUIS URIBE APPROVED " Notes :, ;�. ar � � , �. s.a,'.� ,' ,. F• �; »c ,.'- .F 4 „ �X..; T M . � }. � M '% :T 1 �. •ac : � �' F � .L1tt " J � � r� 10/26/2015 10/26/2015 FRAMING JAKE FUSON DISAPPROwED , Notesr q_ is A- a � •-- .. , _, ,* ^ _ ., .j .r + c G �r k 1 •,, .: .. �.'., V i'.r 4 ,, r�, r $': yl�„ .'` r� "•„1 .+ 5 • 4X6 POSTS MISSING BEAM TO POST HARDWARE MISSING. ADDITIONAL WORK COMPLETED MUST BE ADDED TO SCOPE OF WORK Or PERMIT_r 10/26/2015 10/26/2015 LATH JAKE FUSON NOT READY 'Notes.::} t ,;.. tp "-k f '., �-. iw4 � ` � c`�-1� z •. �. ,7`n ' WORK INCOMPLETE.-= t r c'�%1T OF'CtIFtV - . � . r ';,.�.c..=-;,.. ' ', r,z � .".' � . ,T.•..'' . -.,.s-.1 .. ` u 10/26/2015 10/26/2015 ROUGH ELEC JAKE FUSON DISAPPROVED .Notes SEEFRAMINGCORRECTIONS!ALSO+ELECTRICALINCOMPLETE.`., 10/26/2015 • 10/26/2015 ROUGH PLBG ' JAKE FUSON DISAPPROVED' Notes:.. ^• SEE FRAMING CORRECTIONS, ALSO PLUMBING INCOMPLETE. ` 10/30/2015 10/30/2015 10:15AM FRAMING LUIS URIBE NOT READY . Notes: •. r 3 .x , : _ _.. -. NO ONE ONSITE. NO PLANS. RANG DOOR BELL NO ANSWER. 10/30/2015 10/30/2015 [ lAM •FOOTINGS LUIS URIBE, CANCELED r , Notes: .. ,< 1 j 10A '10/30/201S 10/30/2015 ROUGH ELEC LUIS URIBE NOT READY AM , Notes y`4 Ls:SEE FRAMING NOTES{ vl 10/30/2015 10:30` 10/30/2015 ROUGH MECH LUIS URIBE NOT READY AM r , Notes • .SEE FRAMING NOTES i `a f N s * ' 10/30/2015 10/30/2015 10:30 ROUGH PLBG LUIS URIBE NOT READY • AM Notes ;- s e. r SEE FRAMING,NOTES " " xs �., •x e 1:..i 11%2/2015 11/2/2015 lAM LATH LUIS URIBE DISAPPROVED �y Notes:.; ,:MUST REMOVE OUTDOOR SHOWER.y_ t 12.15 r - 11/3/2015 11/3/2015' LATH LUIS URIBE APPROVED <, r. L Notes „ ,. ,' t s ,; y �. 4 12/1/2015 10:45 12/1/2015AM FRAMING LUIS URIBE PARTIALLY l " APPROVED Notes .C?f PLANS SHOW ONE BEAMATTACHEDTO POOLROOM POCKET: DOOR HEADER. DURING SITE INSPECTION THERE ARE:TWO BEAMS ATTACHED WITH 5^ HANGERS ON THAT BEAM. NEED STRUCTURAL CALCS FOR BOTH CONNECTIONS: APPROVED PARTIAL, OK TO DRYWALL -EXCEPT EAST WALL WERE .. I POCKET DOOR IS LOCATED. ' - '11, r4v st t e ' 12/1/2015 rC 12/1/2015. 10:45 ROUGH ELEC LUIS URIBE PARTIALLYT-1 i AM APPROVED e Notes: "SEE FRAMING NOTES W ry�v _ -.j I a c Printed: Tuesday, 24 January, 2017 ! 2 of 3— Z� C�SYSTEMS ' '. � v �. tii 4i•�. � a OF L1 s` 12/1/2015 4' 12/1/2015 • 10:45 ROUGH-MECHLUIS URIBE, PARTIALLY. .' AM APPROVED ,. y Notes ;:,� ,�,. r �,. rt ..: it i. a :rte ? L ' t " < �i �, 7 j.• , , .' r r 4 Y < +S itie •� t; `t wrr at.` :SEE FRAMING NOTES `k. 12/1/2015'• 10:45 12/1/2015 ROUGH PLBG LUIS URIBE PARTIALLY , AM , _ APPROVED NOtes Y L rr fir. SEE FRAM,ING,NOTES+ Oil`, 12/8/2015 '. 09:30 12/8/2015. DRYWALL NAIL LUIS URIBE APPROVED ,r f e` y s :� •y! AM `� .: , .Y4 y.. ��'" .: -ry. ..� '' •.' L -� ,-,.� . � ,;'� ;.L� '� }. 'F ,, a f.. u r .v r DRYWALL BEAM,INSTALLED OF.P000STORAGE OK PQSTUNDER ON SOUTH SIDE ROOM: DOOR...V` +�r ',�4 •'' rA ` .�r m +'..-•::; - t'``' 1/24/2017 c ! FINAL" DUANE ' CLAYTON .; . _..y •C ,�;� _ .. •S Oil`, .. .. �, � ,r f e` y s :� •y! r `� r ti's, ) f Lv� - '+., ... ; r! � .#' - +� ! A-+• ., '• ' �. �� X� • � • X 1 K• � � I � 1 to � 6.. "� ,/.: Printed: Tuesday,.24 January, 2017' y 3 of 3 ` f ' f t • ' �Adw r SYSTEMS' C Y' Permit Number: BRES2015-0339 Site Address: 53601 AVENIDA VILLA City, State Zip Co'cle: LA QUINTA, CA 92253 Applied: 9/1/2015 Approved: 10/9/2015 Applicant: ALEX TORRES Owner: CHRISTINA MCGRUDER .Contractor: <NONE> Description: MCMAHON CONVERT SINGLE CARPORT TO GARAGE, BATH ANC STORAGE Status: APPROVED Application Received Submitted: 9/1/2015 1st Review Due — 9/9/2015 Actual Completion — 9/10/2015 (Revisions) Picked Up = 9/10/2015 Resubmitted: 9/15/2015 2nd Review Due—, 9/22/2015 Actual Completion = 9/16/2015 (Revisions) Picked Up — 9/16/2015 Resubmitted: 9/21/2015 3rd Review Due — 9/28/2015 Actual Completion — 9/30/2015 Picked Up — 9/30/2015 CITY OF LA QUINTA .SUBS[ -CONTRACTOR IST 5� ('t�z�VkLL� BE 132�52orS=-o3 �l{�L�OI� BUILDER ®" JOB ADDRESS PERMIT NUM R ��NER Oil - _ This form.shall be posted on-the-job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work .> on this job. Any changes to this list must.be approved by the -Building Division prior to commencement of work. .Failure to comply will result in a stoppage of work and/or the voidance +.of building permit. - For each applicable trade, all information .requested below must be cornpleted'b.y.applicant. "On File" is"not an acceptable response: Tra /.. Business cens .. rri an Name CoP P YP � Classificationcense Li ber Num . D � Ex ate Carrier Name N tuber Polic u Y at Exp. Date Licens e Number . Da Ex to P - - e. B C 8 9 A x xx xx x x x/ x x x ! x e: . State F Co and CalComp) 9 P a Varies) (Format a ) xx xx xx / x xx z :. ) x xx x xx / / ( ) Q(iTHW(��i,j�; �it i t'I, it rrr f 77' C S• G U�%G. h / b / Lli (J ((a �o O 3 I �I Ib CONCRETE 8} t� ...( t STRUCT STEEL (C 51) >: n y aVIASgNRY fC 9) ,, sem_ - • . PLUMBINGI'C/LS :....:. ...:....(, ,;:; ) //LYI ' � _ r �• DRYWALL C�)tS'�b2+� CV ) - ELECTRICAA-0.017L ........(..) . ':SHEET METAL (C 43).... .� .. . - - • _ _ :. _ GLAZING. x INS,ULATI,O.[1I:'(C„_).::;::...::::::.. w� r r Z ' .,.,SEWAGE -,--.*,DIS (G- :::. C�ERAMI:Ci<TI.LE�:(C54:}`>`.?; r. 11 ............... ;FENCING.,(C 1:3)..:.. . -- LAN Q. j.. . it � II'll'lllllllllll'll ,.. ,. -T� 3� 4aw VOICE (760) 777-7125 78-495 CALLE TAMPICO s�',q LA QUINT:1, CALIFORNIA 92253 FAX (760) 777-7011 NNEO COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 10/13/2015 Application Number: BRES2015-0339 Owner: Property Address: 53601 AVENIDA VILLA CHRISTINA MCMAHON APN: 774133017 53601 AVENIDA VILLA Application Description: MCMAHON /CONVERT SINGLE CARPORT TO GARAGE, BATH AND �q LA QUINTA, CA 9 25,3 d Property Zoning: STORAGE O Application Valuation: $13,000.00 �T 1 ?��S c/7�F�OF(gQU/NT Applicant: �3 Contractor: 904f, UNI,y ALEX TORRES OWNER/BUILDER OP,!JF,, _ 4 42669 DE ANZA CT INDIO, CA 92203 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.: _ 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 permit subjects the applicant to a civil penalty of not more than five hundred dollars " �(2$50`0).: 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 e 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. 1 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 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: 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 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 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 Date'(.52' _ t Signature(Applic t)N~ FINANCIAL DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE HOURLY PLAN CHECK - YES 101-0000-42600 4 $280.00 $280.00 10/13/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY CHRISTINA MCMAHON CHECK R9949 300 AZA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE HOURLY PLAN CHECK - YES 101-0000-42600 1 $70.00 $70.00 10/13/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY CHRISTINA MCMAHON CHECK R9949 300 AZA Total Paid for BLDG CITY STAFF - PER HOUR: $350.00 $350.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 10/13/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY CHRISTINA MCMAHON CHECK R9949 300 AZA Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, FIRST 1,000SF 101-0000-42403 0 $145.03 $145.03 10/13/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY CHRISTINA MCMAHON CHECK R9949 300 AZA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, FIRST 1,000SF, PC 101-0000-42600 0 $47.86 $47.86 10/13/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY CHRISTINA MCMAHON CHECK R9949 300 AZA Total Paid for ELECTRICAL - NEW CONSTRUCTION: $192.89 $192.89 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE VENT FAN 101-0000-42402 0 $12.09 $12.09 10/13/15 PAID BY METHOD RECEIPT# CHECK# CLTD BY CHRISTINA MCMAHON CHECK R9949 300 AZA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE VENT FAN PC 101-0000-42600 0 $4.83 $4.83 10/13/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY CHRISTINA MCMAHON CHECK R9949 300 AZA Total Paid for MECHANICAL: $16.92 $16.92 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FIXTURE/TRAP 101-0000-42401 0 $72.54 $72.54 10/13/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY CHRISTINA MCMAHON CHECK R9949 300 AZA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FIXTURE/TRAP PC 101-0000-42600 0 $36.27 $36.27 10/13/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY CHRISTINA MCMAHON CHECK R9949 300 AZA DESCRIPTION'- ACCOUNT QTY AMOUNT PAID PAID DATE WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $24.18 $24.18 10/13/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY CHRISTINA MCMAHON CHECK R9949 300 AZA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $12.09 $12.09 10/13/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY CHRISTINA MCMAHON CHECK R9949 300 AZA Total Paid for PLUMBING FEES: $145.08 $145.08 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE REMODEL, EA ADDITIONAL 500 SF 101-0000-42400 0 $43.50 $43.50 10/13/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY CHRISTINA MCMAHON CHECK R9949 300 AZA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE REMODEL, EA ADDITIONAL 500 SF PC 101-0000-42600 0 $17.40 $17.40 10/13/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY CHRISTINA MCMAHON CHECK R9949 300 AZA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE REMODEL, FIRST 100 SF 101-0000-42400 0 $98.62 $98.62 10/13/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY CHRISTINA MCMAHON CHECK R9949 300 AZA DESCRIPTION ACCOUNT QTY , - AMOUNT PAID PAID DATE REMODEL, FIRST 500•SF PC 101-0000-42600 0 $134.88 $134.88 10/13/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY CHRISTINA MCMAHON CHECK R9949 300 AZA Total Paid for REMODEL: $294.40 $294.40 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE SMI - RESIDENTIAL 101-0000-20308 0 $1.69 $1.69 10/13/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY CHRISTINA MCMAHON CHECK R9949 300 AZA Total Paid for STRONG MOTION INSTRUMENTATION SMI: $1.69 $1.69 TOTALS:0i$1,001.98 Description: MCMAHON / CONVERT SINGLE CARPORT TO GARAGE, BATH AND STORAGE � Applied: 9/1/2015 SKH Approved: 10/9/2015 LUR a, Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 242 Lot: 5 PERMIT NUMBER Lot Scl Ft: 0 Building Scl Ft: 0 Zoning: Finaled: 9 'ES No. Buildings: 0 No. Stories: 0 No. Unites: 0 339 Details: WORK STARTED WITH OUT PERMIT DOUBLE FEE WILL BE ASSESSED (CRC R108.6). SEE PICTURES IN TRAKIT FILE DATED 9/29/2015. PERMIT INCLUDES CONVERTING EXISTING 386 SQ. FT. CARPORT TO 400 SQ. FT. GARAGE WITH POOL BATHROOM AND POOL -2- Its COMPLETION DATE NOTES PLAN CHECK COMMENTS Fb0F MFS FROM CONSULTANT KAY HENSEL 9/29/2015 Description: MCMAHON / CONVERT SINGLE CARPORT TO GARAGE, BATH AND STORAGE Type: BUILDING, RESIDENTIAL Subtype: REMODEL Status: ISSUED Applied: 9/1/2015 SKH Approved: 10/9/2015 LUR Parcel No: 774133017 Site Address: 53601 AVENIDA VILLA LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 242 Lot: 5 PERMIT NUMBER Lot Scl Ft: 0 Building Scl Ft: 0 Zoning: Finaled: 9 'ES No. Buildings: 0 No. Stories: 0 No. Unites: 0 339 Details: WORK STARTED WITH OUT PERMIT DOUBLE FEE WILL BE ASSESSED (CRC R108.6). SEE PICTURES IN TRAKIT FILE DATED 9/29/2015. PERMIT INCLUDES CONVERTING EXISTING 386 SQ. FT. CARPORT TO 400 SQ. FT. GARAGE WITH POOL BATHROOM AND POOL -2- Its COMPLETION DATE NOTES PLAN CHECK COMMENTS Description: MCMAHON / CONVERT SINGLE CARPORT TO GARAGE, BATH AND STORAGE Type: BUILDING, RESIDENTIAL Subtype: REMODEL Status: ISSUED Applied: 9/1/2015 SKH Approved: 10/9/2015 LUR Parcel No: 774133017 Site Address: 53601 AVENIDA VILLA LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 242 Lot: 5 Issued: 10/13/2015 AZA UNIT 23 Lot Scl Ft: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $13,000.00 Occupancy Type: Construction Type: Expired: 4/10/2016 AZA No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: WORK STARTED WITH OUT PERMIT DOUBLE FEE WILL BE ASSESSED (CRC R108.6). SEE PICTURES IN TRAKIT FILE DATED 9/29/2015. PERMIT INCLUDES CONVERTING EXISTING 386 SQ. FT. CARPORT TO 400 SQ. FT. GARAGE WITH POOL BATHROOM AND POOL EQUIPMENT STORAGE AREA.. 38 �' 4 ___) Applied to Approved (=Approved to Issued 11 kI u J� M. , I • V'i.� R sf �G ]l mom .{ CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE NOTES PLAN CHECK COMMENTS FROM CONSULTANT KAY HENSEL 9/29/2015 9/29/2015 STRUC RFC 9/28/2015 RECEIVED PLAN CHECK COMMENTS KATHRYN FROM YOUNG ENGINEERING CHECK PLANS AT THE FROM CONSULTANT STEPHANIE GUMPERT 10/7/2015 10/7/2015 COUNTER ON 10-07-15 AND SAID THEY WERE APPROVABLE RECEIVED PLAN CHECK PICKED UP STEPHANIE GUMPERT 9/30/2015 9/30/2015 RICHARD PICKED UP PLANS PLAN CHECK PICKED UP STEPHANIE KHATAMI 9/10/2015 9/10/2015 BY ALEX, THE CORRECTION SHEET WASN'T IN THE FOLDER, HE PLAN CHECK PICKED UP STEPHANIE KHATAMI 9/16/2015 9/17/2015 SAID HE ALREADY KNEN WHAT CORRECTIONS WERE NECESSARY. PLAN CHECK SENT TO MARY FASANO 9/21/2015 9/22/2015 OUTSIDE PC Printed: Tuesday, October 13, 2015 7:45:41 AM 1 of 7 01ILA L� V SYSTEMS Pel'YY11t Det�al�S EEjRENUMBER City of La Quinta BRES2 55-0339 PLAN CHECK SENT TO STEPHANIE GUMPERT 10/7/2015 10/7/2015 OUTSIDE PC PLAN CHECK SUBMITTAL MARY FASANO 9/21/2015 9/22/2015 RECEIVED PLAN CHECK SUBMITTAL STEPHANIE GUMPERT 10/7/2015 10/7/2015 RECEIVED HAPPEN TO DRIVE BY PROPERTY AND NOTICED WAORK HAS BEEN STARTED W/OUT PERMIT. DOUBLE FEE PENALTY WILL BE ASSESSED DUE TO WORK DONE WITH OUT PERMITS. ALEX SITE VISIT LUIS URIBE 9/25/2015 9/25/2015 HAD ASKED ABOUT CONNECTING TO THE SEWER AND WAS TOLD BY AJ AND MYSELF IN TWO SEPERATE OCCASIONS THAT HE WS NOT TO START ANY WORK UNTIL HE OBTAINS A PERMIT. SEE PHOTOS ATTACHED. LEFT VOICEMAIL FOR ALEX THAT I RETURNED HIS CALL AND TELEPHONE CALL BURT HANADA 9/30/2015 9/30/2015 THAT I WILL BE IN THE OFFICE UNTIL 5:30PM TO TAKE HIS RETURN PHONE CALL. TELEPHONE CALL LUIS URIBE 9/10/2015 9/10/2015 LEFT ALEX TORRES A MESSAGE. 1ST REVIEW IS COMPLETE AND PLANS ARE READY TO BE PICKED UP FOR CORRECTIONS. TELEPHONE CALL LUIS URIBE 9/16/2015 9/16/2015 LEFT ALEX TORRES A MESSAGE LETING HIM KNOW 2ND REVIEW IS COMPLETE AND READY FOR CORRECTIONS. ALEX CALLED TO CHECK STATUS OF HIS PLANS. I TOLD HIM TELEPHONE CALL LUIS URIBE 9/25/2015 9/25/2015 THAT I HAVE NOT YET REVIEWED IT AND ADVISED HIM THAT HE NOT TO BE DOING ANY WORK UNTIL HE OBTAINS A PERMIT. HE SAID NO HE HAS NOT DONE ANY WORK. SPOKE WITH CHRISTINA AND LET HER KNOW THAT WORK HAS BEEN STARTED WITH OUT PERMITS. DOUBLE FEE WILL BE ASSESED ON THIS PERMIT. SHE SAID SHE IS UNAWARE THAT WORK HAD BEEN STARTED, ALEX TORRES TOLD HER TELEPHONE CALL LUIS URIBE 9/28/2015 9/28/2015 THAT THE WORK PERFORMED WAS JUST FOR THE POOL. I EXPLANED TO HER THAT HE CAME IN ASKING IF HE COULD CONNECT THE SEWER LINE AND WAS TOLD NO AND DID SO ANYWAYS WITH OUT A PERMIT. HE NEEDS A PERMIT BEFORE HE STARTS ANY WORK. Printed: Tuesday, October 13, 2015 7:45:41 AM 2 of 7 OpeffSYSTEMS Permit Detr ils PERMIT NUMBER r g� -: City of La Quinta BRES�2015-0339 TELEPHONE CALL LUIS URIBE 9/30/2015 9/30/2015 LEFT ALEX TORRES A MESSAGE LETTING HIM KNOW THIRD REVIEW WAS READY FOR CORRECTIONS. TELEPHONE CALL LUIS URIBE 10/9/2015 10/9/2015 LEFT ALEX TORRES A MESSAGE. PERMIT IS READY TO BE ISSUED. - Printed: Tuesday, October 13, 2015 7:45:41 AM 3 of 7 E.d S-� NLU SYSTEMS CLTD DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY HOURLY PLAN CHECK - 101-0000-42600 4 $280.00 $280.00 10/13/15 R9949 300 CHECK CHRISTINA AZA YES MCMAHON HOURLY PLAN CHECK �101_0000-42600 1 $70.00 $70.00 10/13/15 R9949 300 CHECK CHRISTINA AZA YES MCMAHON Total Paid for BLDG CITY STAFF - PER HOUR: $350.00 $350.00 BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 10/13/15 R9949 300 CHECK CHRISTINA AZA MCMAHON Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: RESIDENTIAL, FIRST 101-0000-424030 1 $145.03 1 $145.03 1 10/13/15 1 R9949 1 300 1 CHECK 1 CHRISTINA AZA 1,000SF MCMAHON - Printed: Tuesday, October 13, 2015 7:45:41 AM 3 of 7 E.d S-� NLU SYSTEMS CF'b OF Printed: Tuesday, October 13, 2015 7:45:41 AM 4 of 7 copff SYSTEMS CLTD DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY RESIDENTIAL, FIRST 101-0000-42600 0 $47.86 $47.86 10/13/15 R9949 300 CHECK CHRISTINA AZA 1,000SF, PC MCMAHON Total Paid for ELECTRICAL - NEW CONSTRUCTION: $192.89 $192.89 VENT FAN 101-0000-42402 0 $12.09 $12.09 10/13/15 R9949 300 CHECK CHRISTINA AZA MCMAHON VENT FAN PC 101-0000-42600 0 $4.83 $4.83 10/13/15 R9949 300 CHECK CHRISTINA AZA MCMAHON Total Paid for MECHANICAL: $16.92 $16.92 FIXTURE/TRAP 101-0000-42401 0 $72.54 $72.54 10/13/15 R9949 300 CHECK CHRISTINA AZA MCMAHON FIXTURE/TRAP PC 101-0000-42600 0 $36.27 $36.27 10/13/15 R9949 300 CHECK CHRISTINA AZA MCMAHON WATER SYSTEM 101-0000-42401 0 $24.18 $24.18. 10/13/15 R9949 300 CHECK CHRISTINA AZA INST/ALT/REP MCMAHON WATER SYSTEM 101-0000-42600 0 $12.09 $12.09 10/13/15 R9949 300 CHECK CHRISTINA AZA INST/ALT/REP PC MCMAHON Total Paid for. PLUMBING FEES: $145.08 $145.08 REMODEL, EA 101-0000-42400 0 $43.50 $43.50 10/13/15 R9949 300 CHECK CHRISTINA AZA ADDITIONAL 500 SF MCMAHON REMODEL, EA 101-0000-42600 0 $17.40 $17.40 10/13/15 R9949 300 CHECK CHRISTINA AZA ADDITIONAL 500 SF PC MCMAHON REMODEL, FIRST 100 SF .101-0000-42400 0 $98.62 $98.62 10/13/15 R9949 300 CHECK CHRISTINA AZA MCMAHON REMODEL, FIRST 500 SF 101-0000-42600 0 $134.88 $134.88 10/13/15 R9949 300 CHECK CHRISTINA AZA PCMCMAHON Total Paid for REMODEL: $294.40 $294.40 Printed: Tuesday, October 13, 2015 7:45:41 AM 4 of 7 copff SYSTEMS Perl'Yllt Deta1j5 PERMIT NUMBER City of La Quinta BRE5�2015-0339 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD . BY SMI - RESIDENTIAL 101-0000-20308 0 $1.69 $1.69 10/13/15 R9949 300 CHECK CHRISTINA AZA MCMAHON Total Paid for STRONG MOTION INSTRUMENTATION SMI: $1.69 $1.69 11 v NIX 1, RETURNED STATUS REMARKS REVIEW TYPE REVIEWER SENT DATE DUE DATE NOTES DATE 1ST BLDG NS (1 WK) LUIS URIBE 9/1/2015 9/9/2015 9/10/2015 REVISIONS REQUIRED SEE ATTACHED CORRECTIONS LIST 2ND BLDG NS (1 LUIS URIBE 9/15/2015 9/22/2015 9/16/2015 REVISIONS REQUIRED WK) SEE SECOND REVIEW CORRECTIONS LIST. 1ST BLDG STR (2 YOUNG 9/21/2015 9/28/2015 9/28/2015 REVISIONS REQUIRED WK) ENGINEERING NON-STRUCTURAL REVIEW COMPLETE, WAITING 3RD BLDG NS (2 WK) LUIS URIBE 9/21/2015 9/28/2015 9/30/2015 REVISIONS REQUIRED ON STRUCTURAL CORRECTIONS TO BE RETURNED FOR REVIEW. NON-STRUCTURAL - LUIS URIBE 10/7/2015 10/14/2015 10/9/2015 APPROVED OFFICE SET OF PLANS HAS PLANNING APPROVAL 2 WK SIGNATURE ON SHEET 2 OF PLANS. YOUNG 10/7/2015 10/14/2015 10/7/2015 READY FOR APPROVAL STRUCTURAL - 2 WK j j ENGINEERING Printed: Tuesday, October 13, 2015 7:45:41 AM S of 7 O[ F SYSTEMS Pel'f1'llt Mal -is PERMIT NUMBER City of 054Quinta BRES2015-0339 Printed: Tuesday, October 13, 2015 7:45:41 AM 6 of 7 (ropo SYSTEMS Attachment Type CREATED OWNER DESCRIPTION PATHNAME SUBDIR ETRAKIT ENABLED 1ST REVIEW - NEW CITY DOC 9/28/2015 KATHRYN SAMUELS STRUCTURAL TRANSMITTAL BRES 0 , TRANSMITTAL 2015-0339 (ist).pdf 1ST REVIEW - BRES 2015-0339 KS DOC 9/28/2015 KATHRYN SAMUELS STRUCTURAL (ist).doc 0 COMMENTS 4TH REVIEW - NEW CITY DOC 10/9/2015 KATHRYN SAMUELS STRUCTURAL TRANSMITTAL BRES 0 TRANSMITTAL 2015-0339 (4th).pdf BRES2015-0039 -1ST DOC 9/10/2015 LUIS URIBE 1ST REVIEW REVIEW CORRECTIONS 0 CORRECTIONS LIST LIST.docx BRES2015-0039 - 2ND DOC 9/16/2015 LUIS URIBE 2ND REVIEW REVIEW CORRECTIONS 0 CORRECTIONS LIST LIST.docx BRES2015-0039 - 3RD DOC 9/30/2015 LUIS URIBE 3RD REVIEW REVIEW CORRECTIONS 0 CORRECTIONS LIST LIST.docx BRES2015-0339 - DOC 10/12/2015 LUIS URIBE PLANNING APPROVAL PLANNING APPROVAL 0 NOTE NOTE.pdf CHECK LIST 4TH CHECK LIST 4TH DOC 10/7/2015 STEPHANIE GUMPERT SUBMITTAL SUBMITTAL 0 COMMENTS.pdf COMMENTS.pdf DOC 9/1/2015 STEPHANIE KHATAMI OWNER BUILDER ID.pdf OWNER BUILDER ID.pdf 0 2ND SUBMITTAL 2ND SUBMITTAL DOC 9/15/2015 STEPHANIE KHATAMI CHECKLIST AND CHECKLIST AND 0 COMMENTS 09-15- COMMENTS 09-15- 15.pdf 15.pdf Printed: Tuesday, October 13, 2015 7:45:41 AM 6 of 7 (ropo SYSTEMS Pert"1'llt Det►a1�5 PERMIT NUMBER �: City of La Quinta BRES2015-03.39 .:%k JJ yv •1 ;.1. t�:+{,:.G:- `i.` c 'r is ti x M•t•t. ✓ Attachment Type CREATED OWNER DESCRIPTION PATHNAME SUBDIR ETRAKIT ENABLED BRE52015-0339 -WORK IMAGE 9/28/2015 LUIS URIBE WORK STARTED WOUT STARTED WOUT PERMIT 0 PERMIT 1 1.J PG BRES2015-0339 - WORK IMAGE 9/28/2015 LUIS URIBE WORK STARTED WOUT STARTED WOUT PERMIT 0 PERMIT 2 2.JPG BRES2015-0339 - WORK IMAGE 9/28/2015 LUIS URIBE WORK STARTED WOUT STARTED WOUT PERMIT 0 PERMIT 3 3.J PG BRES2015-0339 - WORK IMAGE 9/28/2015 LUIS URIBE WORK STARTED WOUT STARTED WOUT PERMIT 0 PERMIT 4 4.1PG BRES2015-0339 - WORK IMAGE 9/28/2015 LUIS URIBE WORK STARTED WOUT STARTED WOUT PERMIT 0 PERMIT 5 5.J PG BRES2015-0339 - WORK IMAGE 9/28/2015 LUIS URIBE WORK STARTED WOUT STARTED WOUT PERMIT 0 PERMIT 6 6.JPG BRES2015-0339 - WORK IMAGE 9/28/2015 LUIS URIBE WORK STARTED WOUT STARTED WOUT PERMIT 0 PERMIT 7 7.J PG BRES2015-0339 - WORK IMAGE 9/28/2015 LUIS URIBE WORK STARTED WOUT STARTED WOUT PERMIT 0 PERMIT 8 8.JPG BRES20IS-0339 - WORK IMAGE 9/28/2015 LUIS URIBE WORK STARTED WOUT STARTED WOUT PERMIT 0 PERMIT 9 9.JPG BRES2015-0339 - WORK IMAGE 9/28/2015 LUIS URIBE WORK STARTED WOUT STARTED WOUT PERMIT 0 PERMIT 10 10.JPG Printed: Tuesday, October 13, 2015 7:45:41 AM 7 of 7 LWNV— SYSTEMS 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING &. SAFETY DEPARTMENT (760) 777-7012 FAX (760) 777-7011 Considering Becoming an Owner -]wilder? 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 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 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 aird.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 valried`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 ivoriners 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 fled an exemption from Workers Comp. ■ Owner-Ruilder hires.6rother-in-law to install anew 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 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 ah"'erriployer" 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 RESPONS(B[LITY--rOR YOUR CONSTRUCTION PERMIT P.O. BOX. 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPE TY EIR' 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 Ourncr: An application for a building permit has been submitted in yoname listing yourself as the builder of the property improvements specked at S - to 0 ! � V , l) A 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 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 VERIF'ICA'TION OF INFORMATION DIRECTIONS: Read and initial each statement below to signify you understand or verify' this information. 'MI. 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 ownlabor 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 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. 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. �. 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. . I understated Contractors are required by law to be licensed and bonded in California and to list their license mirmbers 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 "employee' under state andfederal.law. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, witlihold pay'xoIl taxes, provide workers' compensation disability insurance, and contribute to unempJo}7nenr compensation for each 'empl-oyee." I also understand my failure to abide by these laws may subject me to serious financial risk. 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 does not exceed four widein any calendar year, or all of the work is performed under contract with a licensed general building Contractor. t 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. CM9. I understand I may obtain more information 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.csib.ca.gov formore information about licensed contractors. C -H 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: 53b01 b-yeti;01 VwlNVA C-" 11. 1 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. t% fVA 12. 1 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 rtsult �P a complaint Your only remedy against unlicensed Cl o uacLuia may ue 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 perinit can be issued, this form must be completed and.signed by the property owner and returned to the agency responsible for issuing the permit. li'ate:' %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 property owner Date:oc--` (f-- 13 Note: The following Authorization Form is required lobe 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 OV 1NER'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: -5.3401 Name of Authorized Agent: 13,� Address of Authorized Agent: 1;3 ts 0,/ i-1 �� �,^ 1 V -1b 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 verifcation acceptable to the agency is required to presented when the permit is issued to verify thepropertyowners signature. Properry. Owner's Signature: ��--- - — ---�`T Bate: U(, -'i V231