BELC2017-006178-495 CALLE TAMPICO C1 0 Q�
D
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: ' BELC2017-0061
Property Address:
56905 VILLAGE DR
APN:
764050030
Application Description:
JOHNSON / METER REPAIR
Property Zoning:
LA QUINTA, CA 92253
Application Valuation:
$200.00
Applicant:
_ I have and will maintain workers' compensation insurance, as required by
GREGORY JOHNSON
Section 3700 of the Labor Code, for the performance of the work for which this permit is.
78365 HIGHWAY 111 STE
177
LA QUINTA, CA 92253.
Policy Number: _
Ca�not
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/29/2017
Owner:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
GREGORYJOHNSON
{commencing with Section 70001 of Division 3 of the Business and Professions Code, and
_ I have and will maintain a certificate of consent to self -insure for workers'
78365 HIGHWAY ill`STE T7-"
LA QUINTA, CA 92253
3
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
Policy Number: _
Ca�not
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
—rtify 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
shloy any person in any manner so as to become subject to the workers'
Contractor:
S
structure, prior to its issuance, also requires the applicant for the permit to file a signed
OWNER BUILDER
statement that he or she is licensed pursuant to the provisions of the Contractor's State
comply with those provisions.
Llc. No.:
�J
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
1 hereby affirm under penalty of perjury one of the following declarations:
{commencing with Section 70001 of Division 3 of the Business and Professions Code, and
_ I have and will maintain a certificate of consent to self -insure for workers'
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
Policy Number: _
Ca�not
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
—rtify 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
shloy any person in any manner so as to become subject to the workers'
city or county that requires a permit to construct, alter, improve, demolish, or repair any
compensation laws of California, and agree that, if I should become subject to the
structure, prior to its issuance, also requires the applicant for the permit to file a signed
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
statement that he or she is licensed pursuant to the provisions of the Contractor's State
comply with those provisions.
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
Date: Applicant:
alleged exemption. Any violation.of Section 7031.5 by any applicant for a permit
T�
s bj cts the applicant to a civil penalty of not more than five hundred dollars ($500).:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, `
-1-a s owner of the property, or my employees with wages as their sole
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
(compensation, will do the work, and the structure is not intended or offered for sale.
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
apply to an owner of property who builds or improves thereon, and who does the work
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
within one year of completion, the owner -builder will have the burden of proving that he
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
or h 'did not build or improve for the purpose of sale.).
the conditions and restrictions set forth on this application.
( I as owner.of the property, am`exclusively contracting with licensed contractors to
eco
1..Each person upon whose behalf this application is made, each person at whose
struct the project. (Sec. 7044, Business and Professions Code: The Contractors' State
request and for whose benefit work is performed under or pursuant to any permit issued
License Law does not apply to an owner of property who builds or improves thereon,
as a result of this application , the owner, and the applicant, each agrees to, and shall
and who contracts for the projects with a contractor(s) licensed pursuant to the
defend, indemnify and hold harmless the City of La Quints, its officers, agents, and
actors' State License Law.).
employees for any act or omission related to the wof k being performed under or
,-(V—iI am exempt under Sec. B.&P.C. for this reason
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not
at Owner:- `A
commenced within 180 days from date of issuance of such permit, or cessation of work
for 180 days
�D
will subject permit to cancellation.
CONSTRUCTION LENDING AGENCY'.
I certify that I have read this application and state that the above information is correct.
I hereby affirm under penalty of perjury that there is a construction lending agency forI I agree to comply with all city and county ordinances and state laws relating to building
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). ' construction, and hereby authorize representatives of this city to enter upon the above -
Lender's Name: t.
Lender's Address:
mentioned property for inspection purposes.
Sat � % � ! Signature (Applicant or Agent)•
l
Date: 6/29/2017
Application Number: BELC2017-0061
Owner:
Property Address: 56905 VILLAGE DR
GREGORY JOHNSON
APN: 764050030
78365 HIGHWAY 111 STE 177
Application Description: JOHNSON/ METER REPAIR
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $200.00
Applicant:
Contractor:
GREGORY JOHNSON
OWNER BUILDER
78365 HIGHWAY 111 STE 177
LA QUINTA; CA 92253.'
CIc. No.:
Detail: ELECTRICAL - PANEL REPAIR. 2016 CALIFORNIA BUILDING CODES.
{
i
r
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.
$25.33
DESCRIPTION
ACCOUNT
QTY
•AMOUNT
OTHER ELECTRICAL EQUIPMENT PC
101-0000-42600
0
$25.33
Total Paid for ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT
QTY
AMOUNT.
PERMIT ISSUANCE
101-0000-42404
0
$96.27.
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
•1
9
BUILDING*& SAFET•Y,DEPARTMENT
w
C� O¢ 78-495 CALLE TAMPIC0
`SOF I (760).717-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 .
Considering Becoming an Owner-Buiider.?
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.
Bene iit/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 personallyresponsible for the construction management, knowledge, workmanship, and completion of the job. You
benefit by not paying others to perform this work for you and your risk depends on your own ability to complete the job.successfully.
Benefit/Risk:. Possible Benefit with Low Financial Risk
Owner=as-Contractor is a type of Owner -Builder where'you personally act as your own General Contractor, the permit is taken out in
your name and you hire California licensed sub -contractors to perform portions of the construction work. WARNING: The benefit of
protection provided by law when you hire, only California licensed sub -contractors can turn to serious financial risk cif you hire
unlicensed contractors. to perform any of the work-
Benefit/Risk:.
ork Benefrt/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 turnto'serious financial
risk if you fail to deduct payroll taxes or provide workers compensation insurance for each worker.
Benefit/Risk: Possible Benefit with Sieniticant Financial Risk
ro
F.
^S
9
BUILDING*& SAFET•Y,DEPARTMENT
w
C� O¢ 78-495 CALLE TAMPIC0
`SOF I (760).717-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 .
Considering Becoming an Owner-Buiider.?
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.
Bene iit/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 personallyresponsible for the construction management, knowledge, workmanship, and completion of the job. You
benefit by not paying others to perform this work for you and your risk depends on your own ability to complete the job.successfully.
Benefit/Risk:. Possible Benefit with Low Financial Risk
Owner=as-Contractor is a type of Owner -Builder where'you personally act as your own General Contractor, the permit is taken out in
your name and you hire California licensed sub -contractors to perform portions of the construction work. WARNING: The benefit of
protection provided by law when you hire, only California licensed sub -contractors can turn to serious financial risk cif you hire
unlicensed contractors. to perform any of the work-
Benefit/Risk:.
ork Benefrt/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 turnto'serious financial
risk if you fail to deduct payroll taxes or provide workers compensation insurance for each worker.
Benefit/Risk: Possible Benefit with Sieniticant 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 ahead 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 -Builders 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. 80X,1504
e LA QUINTA, CALIFORNIA 92247-1504 BUILDING & SAFETY. DEPARTMENT
oF11'�9 78-495 CALLS TAMplco (760) 777-7.012
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 buildin peimit has been s}}�witted in your name listing yourself as . the, builder of the property
improvements specified at _ �j (� V� l
We are providing you with an Owner
Acknowl ent and Information Verification Form to -make you aware of your
responsibilities and possible risk you may incur by having this permit issuedinyour 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 ilris notice
unless you, the property owner; obtain the prior approval of.the permitting authority.-
OWNER'S
uthority:OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
.DIRECTIONS. Read and initial each statement below to signs you understand or verify this information.
! 1. I -understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
ilding permit that erroneously implies.that the property owner is providing his or her own labor and material personally. I, as
an Owner -Builder, maybe held liable• and subject to. serious financial risk for any injuries sustained by an unlicensed person
and his or her, eriiployees 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.
t/2. I understand building permits are not. required to be. si ed' b roe •
gn y property rty owners unless they are responsible for the
constriction and -are not hiring.a licensed Contractor to assume this responsibility.
3. I understand as an "Owner -Builder" I am the responsible party of record on the permit l understand that'l may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his other name instead of my
own.
VwI understand Contractors are required.by law to be licensed and bonded'in California and to list their license numbers on
uts and contracts.
15. I understand -if I employ or otherwise engage any persons, other"than California licensed ''Contractors, and the total value
6f"my construction is at least five hundred dollars
($500), .in 1
c uding labor and materials, I may be.considered an "employer
under state and federal law:.
understand if I am considered an "employer" understate and federal law, I must register with the state and federal
&6.1
rnment, withhold' a o1I taxes rovide w
P.Yr. , p workers' compensation disability insurance; and contribute'to unemployment
compensation for each "employee:" I also. understand my failure to abide by these laws may subject me to.s unemployment
financial
risk.
g7. I understand under California Contractors' State License Law, an Owner -Builder who builds. single-family residential
fractures. 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 yearor all's, 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.
A. A.9. 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.cslb.ca.gov for more information about licensed contractors.
10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
arty legally, and financially responsible for proposed construction activity at the following address:
I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the infomration I
te provided on this. form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
eone 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 in while working
on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and. wish to hire Contractors,
you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or
other verification acceptable to the agency is required to be presented when the permit is issued to verify the property
owner's signature.
Signature of property owner Date: 2 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 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. o
Scope of Construction Project (or Des/ccrripgtion of Work): &zb4
Project Location or Address: �V G , , �, n G,)t 1,i;_
Name of Authorize
&Agent: (/1� `��'J (� N Tel No
Address of Authorized Agent:
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 t be esented when the perntit is issued to verify the property owners signature.'
Property Owner's Signature: Date: 6—
Bin #
0ty of LA uinta
Building & Safety Division
78-495 Calle Tampico.
La Quinta, CA 92253 - (760).777-7012
Building Permit 6pplication and Tracking Sheet
Permit #
_
'ProAddress: �y
J�% VS
Owner's Name:
UN
A. P. Number:
Address:
Legal Description:
`C ty; ST, Zip:
Contractor:
h
-Telephone: 6
Address:
Project Description:
City, ST, Zip:
Telephone: hone-
State Lic. # :
City Lic. #;
Arch., Engr., Designer
Address:
City, ST, Zip:
Telephone: t
:Lf�.'-iiia:;{:::;h`:;i: i:-:v-:J:i:i!i:}::;:::j
...........
Construction Type: Occupancy.:
Occu cY:
State Lic. #:
ProJect type (circle one): New Add'n' Alter Repair Demo
zNam of Contact Person:
ro CN r ��Cj (�
Sq. Ft:
#Stones:
# Units:
Telephone # of Contact Person: /
eP 6 � �%� . ��•Estima-ted
_
Value of Project:
APPLICANT: -DO NOT 'WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item _
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss talcs.
Called Contact Person
Plan Check Balance
Title N Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"" 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 .1m pact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees