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BRES2015-043278-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4'!t 4 -4 Qubtz' COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BRES2015-0432 Property Address: 48228 VISTA DE NOPAL APN: 646110007 Application Description: MORLOCK / CAN LIGHTS, RECEPTACLES, SHOWER DRAINS, GAS LINE Property Zoning: Application Valuation: $4,500.00 Applicant: MORLOCK GARY P & MARJORIE S 48228 VISTA DE NOPAL 48228 VISTA DE NOPAL LA QUINTA, CA 92253 LA QUINTA, CA 92253 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 ($500).: ✓I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that h she did not build or improve for the purpose of sale.). I, as owner of the property, am exclusively contracting with licensed contractors 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 they h, and who contracts for the projects with a contractor(s) licensed pursuant to t ontractown' State License Law.). I am exempt under Sec. . B.&P.C. for this reason Date: �� Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for -the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). - Lender's Lender's Address: Owner: 11111111111111111111 44 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/18/2015 MORLOCK GARY P &•MARJORIE S 48228 VISTA DE NOPAL LA QUINTA, CA 92253 jM=� Contractor. MORLOCK GARY P & MARJORIE S j "= 48228 VISTA DE NOPAL LA QUINTA, CA 92253 C _' 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 polity number are: Carrier: Policy Number: _ I certify that in the performance of the work for which this permit is issued, I sh t 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,. ht Labor Code, I shall forthwith comply with those provisions. Date: J/ Applica 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 ente' r o . -the above-mentioned property for inspection purposes. Date:�� �� ��S Signature (Applicant or Ag DESCRIPTION FINANCIAL INFORMATION ACCOUNT Y AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 $1.00 $1.00 Fc 11/18/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY MORLOCK GARY P & MARJORIE S CHECK R10954 1475 SKH Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 $1.00 DESCRIPTION. ACCOUNT QTY AMOUNT PAID PAID DATE DEVICES, ADDITIONAL 101-0000-42403 0 $55.66 $55.66 11/18/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY MORLOCK GARY P & MARJORIE S CHECK R10954 1475 SKH DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DEVICES, ADDITIONAL PC 101-0000-42600 0 $13.80 $13.80 11/18/15 -PAID BY METHOD RECEIPT # CHECK # CLTD BY MORLOCK GARY P & MARJORIE S CHECK R10954 1475• SKH DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DEVICES, FIRST 20 101-0000-42403 0 $24.17 $24.17 11/18/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY MORLOCK GARY P & MARJORIE S CHECK R10954 1475 SKH DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 $24.17 11/18/15 PAID BY METHOD RECEIPT # ` CHECK # CLTD BY MORLOCK GARY P & MARJORIE S CHECK R10954 1475 SKH Total Paid for ELECTRICAL: $117.80 $117.80 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FIXTURE/TRAP 101-0000-42401 0 $48.36 $48.36 11/18/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY MORLOCK GARY P & MARJORIE S CHECK R10954 1475 SKH DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FIXTURE/TRAP PC 101-0000-42600 0 $48.36 $48.36 11/18/15 PAIDBY METHOD RECEIPT# CHECK'# CLTD BY MORLOCK GARY P & MARJORIE S CHECK R10954 1475 SKH DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE GAS SYSTEM, 1-4 OUTLETS 101-0000-42401 0 $12.09 $12.09 11/18/15 PAID BY METHOD RECEIPT #. CHECK # CLTD BY MORLOCK GARY P & MARJORIE S CHECK R10954 1475 SKH DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE GAS SYSTEM, 1-4 OUTLETS PC 101-0000-42600 0 $24.17 $24.17 11/18/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY MORLOCK GARY P & MARJORIE S CHECK R10954 1475 SKH DESCRIPTION ACCOUNTQTY AMOUNT PAID PAID DATE WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $12.09 $12.09 11/18/15 777- pg -i� p PAID N q AIMBY , 4 �M, � TV5 N kid 0. .5 =m A 9N, LTMBy,-41-I p, N.11. EMIR N'T MORLOCK GARY P & MARJORIE.S CHECK 1110954 1475 SKH DESCRIPTION .-�ACCOUNT MT m V MEN ID WATER SYSTEM INST/ALT/REP PC 101-0000-42600, $12.09 $12.09 11/18/15 P A r, I D BYf'� `011 N, - NIS MORLOCK GARY P & MARJORIE S'. CHECK 11.10954' 1 . 475 SKH w 'Total Paid for PLUMBING FEES: $157.16 $157.16 1 �;.'O J� g, 011 DESCRIP ON'4&1,m it. .4 '-, , , - �',-ACCOUNT-- �E , IN , A WT XDAT& V'd My 11 "10, i"N., 'i NO TAII REMODEL, EA ADDITIONAL .500 SF :101-0000-42400 0 a $21475$21.75 11/18/15 ETHOD g g� T MtNAOR A K1# .,qM MORLOCK GARY P & MARJORIE S CHECK,,: R10954 1475 SKH - A ;:DESCRIPTION , ACCOUNTS 7' F6 JM" Ty04-7M JNul . RrM"M � R 0 U R �� U �., U - , '0MMN ,kgX- INqA rtU REMODEL,-EA ADDITIONAL 500 SF PC :-'-101-0000-42600 0 $17.40' $17.40 11/18/15 -M ,M�' INU -XI;Vrio,TIVWWNNq t a'k•4`PAIR� RECEIP I4; ng CHECKI �m)N' 'METHO "M ., , 1TVZY- MORLOCK GARY P & MARJORIE S CHECK R10954 1475 SKH * "'DESCRIPTIONs,I., MR - , . - 00, Y , m MO IN E MEN Kp- X Mil E`R t-mv s -MMACCOUNTER, s. x 9"gM tf�RDATE� REMODEL; FIRST 100 SF, 101-0000-42400 -0L $49.31 $49.31 11/18/15 'A -011t.1'.:44 31*14"N' Or lu.1val" METHOD 'm we A1 CLTD BYE, ORN-51 -4;RrM�XHECKV MORLOCK GARY, P & MA RJORIE.S CHECK 1110954 1475 SKH �i; DESC-RIIqMONR§ i�4 CC L iQT. Y4 AMOUNT NT,� PAID PAID DATE No 'I'A T iv!; 1111 u� ,P, REMODEL, FIRST,SOOSF PC '101-'0000-42600 , 0 $134.88 $134.88 11/18/15 PAII MMN- ETHi N0 OR j- Ali.,,i-�-;.. ..-, 4iftHIECK, CLTMBY ,, MORLOCK GARY P & MARJORIE S CHECK 1110954 1475 SKH 'Total Paid for REMODEL: $22334 $223.34 CRIRT 15 v -0.t� W 41d ��'j m PAID�.PAIPjpATEI, -.DES DPW' SMI - RESIDENTIAL $0.59 $0.59 .11/18/15 W. ` PAID BYE212NNMI W V: %vt aY HIM X, 51-F115TR— �:WwXXVV,v s -U MORLOCK GARY P & MARJORIE S CHECK -1110954 - '1475 SKH Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0,.59 $0.59 q Permit Details PERMIT NUMBER City of La Quinta BRES2MS "04. Description: MORLOCK / CAN LIGHTS, RECEPTACLES, SHOWER DRAINS, GAS LINE Type: BUILDING, RESIDENTIAL Subtype: REMODEL Status: APPROVED Applied: 11/12/2015 SKH Approved: 11/17/2015 JFU Parcel No: 646110007 Site Address: 48228 VISTA DE NOPAL LA QUINTA,CA 92253 Subdivision: TR 13640-1 Block: Lot: 7 Issued: Lot Scl Ft: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $4,500.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: INTERIOR REMODEL. INSTALL NEW LED LIGHITNG THROUGHOUT HOUSE AND ADD RECEPTACLES AT KITCHEN AND BATHS. NEW PONY WALLS AT KITCHEN AND BATHS, ADD RANGE AT NEW ISLAND AT KITCHEN. DOWNSIZE WINDOW AT MASTER BATH SHOWER. MOVE SHOWER DRAINS AND ADD NEW SINK. NEW CABINETS AND APPLIANCES AT KITCHEN. 2013 CALIFORNIA BUILDING CODES. CHRONOLOGY TYPE. STAFF NAME CHRONOLOGY ACTION DATE COMPLETION DATE NOTES PLAN CHECK SUBMITTAL RECEIVED STEPHANIE KHATAMI 11/12/2015 11/12/2015 TELEPHONE CALL JAKE FUSON 11/17/2015 11/17/2015 NOTIFIED GARY MORLOCK THAT PLANS WERE APPROVED AND PERMIT WAS READY TO ISSUE. CONDITIONS NAME TYPE NAME ADDRESSI CONTACTS CITY STATE ZIP PHONE FAX EMAIL - APPLICANT MORLOCK GARY P & MARJORIE S 48228 VISTA DE NOPAL LA QUINTA CA 92253 CONTRACTOR MORLOCK GARY P & MARJORIE S 48228 VISTA DE NOPAL LA QUINTA CA 92253 OWNER MORLOCK GARY P & MARJORIE S 48228 VISTA DE NOPAL LA QUINTA CA 92253 FINANCIAL INFbRIVIAtION Printed: Wednesday, November 18, 2015 2:38:12 PM 1 of 3 CPW SYS7ElNS Printed: Wednesday, November 18, 2015 2:38:12 PM 2 of 3 cf SYSTEti1S CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE ' RECEIPT # CHECK # METHOD PAID BY , BY .. BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 11/18/15 R10954 1475 CHECK MORLOCK GARY P & SKH MARJORIE S Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: DEVICES, ADDITIONAL 101-0000-42403 0 $55.66 $55.66 11/18/15 R10954 1475 CHECK MORLOCK GARY P & SKH MARJORIE S DEVICES, ADDITIONAL 101-0000-42600 0 $13.80 $13.80 11/18/15 R10954 1475 CHECK MORLOCK GARY P & SKH PC MARJORIE S DEVICES, FIRST 20 101-0000-42403 0 $24.17 $24.17 11/18/15 R10954 1475 CHECK MORLOCK GARY P & SKH MARJORIE S DEVICES, FIRST 20 PC 101-0000-426000 $24.17 $24.17 11/18/15 R10954 1475 CHECK MORLOCK GARY P & SKH MARJORIE S Total Paid for ELECTRICAL: $117.80 $117.80 FIXTURE/TRAP 101-0000-42401 0 $48.36 $48.36 11/18/15 R10954 1475 CHECK MORLOCK GARY P & SKH MARJORIE S FIXTURE/TRAP PC 101-0000-42600 0 $48.36 $48.36 11/18/15 R10954 1475 CHECK MORLOCK GARY P & SKH MARJORIE S GAS SYSTEM, 1-4 101-0000-42401 0 $12.09 $12.09 11/18/15 R10954 1475 CHECK MORLOCK GARY P & SKH OUTLETS MARJORIE S GAS SYSTEM, 1-4 101-0000-42600 0 $24.17 $24.17 11/18/15 R10954 1475 CHECK MORLOCK GARY P & SKH OUTLETS PC MARJORIE S WATER SYSTEM 101-0000-42401 0 $12.09 $12.09 11/18/15 R10954 1475 CHECK MORLOCK GARY P & SKH INST/ALT/REP MARJORIE S WATER SYSTEM 101-0000-42600 .0 $12.09 $12.09 11/18/15 R10954 1475 CHECK MORLOCK GARY P & SKH INST/ALT/REP PC MARJORIE S Total Paid for PLUMBING FEES: $157.16 $157.16 REMODEL, EA 101-0000-424000 $21.75 $21.75 11/18/15 R10954 1475 CHECK MORLOCK GARY P & SKH ADDITIONAL 500 SF MARJORIE S Printed: Wednesday, November 18, 2015 2:38:12 PM 2 of 3 cf SYSTEti1S DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY REMODEL, 101-0000-42600 0 $17.40 $17.40 11/18/15 R10954 1475 CHECK MORLOCK GARY P & SKH ADDITIONAL 5000 SF PC MARJORIE S REMODEL, FIRST 100 SF 101-0000-42400 0 $49.31 $49.31 11/18/15 R10954 1475 CHECK MORLOCK GARY P & SKH MARJORIE S REMODEL, FIRST 500 SF 101-0000-42600 0 $134.88 $134.88 11/18/15 R10954 1475 CHECK MORLOCK GARY P & SKH PC MARJORIE S Total Paid for REMODEL: $223.34 $223.34 SMI - RESIDENTIAL 101-0000-20308 0 $0.59 $0.59 11/18/15 R10954 1475 CHECK MORLOCK GARY P & SKH MARJORIE 5 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.59 $0.59 $499.89 $499.89 INSPECTIONS PARENT PROJECTS BOND INFORMATION ATTACHMENTS Printed: Wednesday, November 18, 2015 2:38:12 PM 3 of 3 . r7LJ LJ SYSTEtitS Din # Cf ty . of La Quin to Building 81• Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: `f�' g `S7 l o n� ` Owner.'s Name`. 61W,- y A. P. Number: Address: Legal Description: City, ST, Zip: Contractor: Address: A2A ifL Telephone: — Project Description: � 1i ��,v Z—/,f City, ST, Zip: hone: Telephone: State Lic. # : City Lie. #.:�XIA) Arch., Engr., Designer: Address: A IJ A City, ST, Zip: r. LrG. 7�S E //t% /V7Gh`in/7D I4 I54 A Telephone: Construction Type: Occupancy: #: State Lie. : Ne w Add'n Alter Repairair Demo ProJecttYPe�cir e one): Name of Contact Person: 6/1510/9,, ` ��� Sq. Ft.: # Stori #Units: Telephone # of Contact Person: S ` 2 2 Estimated Value of Project- 4 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance. Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2pd Review, ready for correctionstissue 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 correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees, Total Permit Fees r� • u��ttcv , P.O. Box 1504 LA QUINTA, CALIFORNIA- 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (760) 777-7012 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 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 per 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 and you hire California licensed sub -contractors to perform portions of the construction work. WARNING: The benefit of protection provided by law when you hire only California licensed sub -contractors can turn to serious financial risk if you hire unlicensed contractors to perform any of the work. Benefit/Risk: Possible Benefit and Significant Financial Risk Owner -as -Employer is a type of Owner -Builder where you pay any unlicensed individual to perform any construction work valued at more than $500.00, the permit is taken out in your name and you are personally responsible for their employment requirements, supervision, performance, safety and welfare while on your property. WARNING: Cost savings benefit can turn to serious financial risk if you fail to deduct payroll taxes or provide workers compensation insurance for each worker. Benefrt/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. 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 J� P.O. Box 1.504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'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 Owner: An application for a building permit has been submitted `,in� your name listing yourself as the builder of the property improvements specified at g- a _ //� J7W r� /VOIrW , 2W ra, L'v'r Weare providing you -with an Owner -Builder Acknowledgment and ldformation 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 VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. 41. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. -04 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. -A-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 his or her name instead of my own. 4.1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on' pe 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" ��lc�pf state and federal law. /1 %6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide 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 serious financial 17. 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 within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 10�114 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 X nship or materials. 1 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. _,0410. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party "In -A;'19 and financiall responsible �/� for roposed co truction activity at the following address: "IU -A;'19 .- / y0 /QRZ t l�il t�rd Ti4 �/� 1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all able 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 ha a 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 agenc is re rred to be presented when the permit is issued to verify the property owner's signature. /�� Signature of property owne Date: //—/ "7— " 4 -- 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 AuthorizedAgent: 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 verb the property owner's signature. Property Owner's Signature: Date: . t t CITY. OF LA QUINTA..SUB-CONTR CTOR LIST JOB ADDRESS yB oZo��' U/SyN ��/`��1'� PERMIT. NUMBER OWNER cc+c,�[— _ BUILDER �y /`G�B�L6ilL 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 compieted by applicant. "On File" is not an acceptable response. Ol vN&-�L-- MAS,ONRY>fC=2:9�);>:r;>=�>'<j I C) c,0Nr7t— AS:TE.R; i C< .: OW N&7,2- t :ELEC:TRICAL'(G 1 .............. N �,rZ i300FING' C=39`< < z:>> .. .1 u SENVAGF`DISF .. 42) : ;. PAINTING C'.=33 . _._ ._...___... .._.................