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BRES2016-0033I , • t 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 4 Xfv Quiltro COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BRES2016-0033 Property Address: 52471 AVENIDA MARTINEZ APN: 773301013 Application Description: GALCERAN / CHANAGE OUT (5) WINDOWS Property Zoning: Application Valuation: $1,000.00 Applicant: AGUILAR-GALCERAN MELISSA/GALCERAN ROBERT' 52471 AVENIDA MARTINEZ 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: rLiiccense No.: Date: `t`-10- U0 Contractor: . %_�A 4, 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 5 ).: as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended dr 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 "he did not build or improve for the purpose of sale.). as owner of the property, am exclusively contracting with licensed contractors t.struct.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 r ason Date. Z_—k(>—Q0 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 I i IIIII� �IIII III I��I 02 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS(760)777-7153 Owner: AGUILAR-GALCERAN MELIS 52471 AVENIDA MARTINEZ LA QUINTA, CA 92253 Contractor: AGUILAR-GALCERAN•MELISS/ 52471 AVENIDA MARTINEZ LA QUINTA, CA 92253 Llc. No.: 6 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 oNeork for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Se00 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: _ Polity 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,1 shall forthwith comply with those provisions. _ k A Date: ��`17Applicant: 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 purposes. M „ -1 N J Date: ?. - `d ^1 & • Signature (Applicant or Agent): FINANCIAL •• !. DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: ' $1.00 $0:00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE SMI - RESIDENTIAL 101-0000-20308 0 $0.50 $0.00 PAID BY METHOD ' RECEIPT # CHECK # CLTD BY Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.50 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DOOR/WINDOW, REPLACE FIRST 7 101-0000-42400 0 •$60.91 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID- PA6DATE DOOR/WINDOW, REPLACE, FIRST 7 PC 101-0000-42600 0 $110.22 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for WINDOW/SLIDING GLASS DOOR/FENESTRATION: $171.13 $0.00 TOTALS:•0 Description: GALCERAN / CHANAGE OUT (5) WINDOWS CONDITIONS Type: BUILDING, RESIDENTIAL Subtype: REMODEL Status: APPROVED Applied: 2/10/2016 SKH Approved: 2/10/2016 SKH Parcel No: 773301013 Site Address: 52471 AVENIDA MARTINEZ LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 108 Lot: 1 Issued: UNIT 11 NAME ADDRESS1' Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $1,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 LA QUINTA Details: CHANGE OUT (5) WINDOWS. 2013 CALIFORNIA BUILDING CODES. 92253 ADDITIONAL SITES CHRONOLOGY CONDITIONS CONTACTS NAME TYPE NAME ADDRESS1' CITY STATE ZIP PHONE APPLICANT AGUILAR-GALCERAN MELISSA./ 52471 AVENIDA LA QUINTA CA 92253 GALCERAN ROBERT MARTINEZ CONTRACTOR AGUILAR-GALCERAN MELISSA/ 52471 AVENIDA LA QUINTA CA 92253 GALCERAN ROBERT MARTINEZ OWNER AGUILAR-GALCERAN MELISSA/ 52471 AVENIDA LA QUINTA CA 92253 GALCERAN ROBERT MARTINEZ Printed: Wednesday, February 10, 2016 10:03:19 AM 1of2 DESCRIPTION -ACCOUNT QTY AMOUNT: PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD " BY: BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: SMI - RESIDENTIAL 101-0000-20308 0 $0.50 $0.00 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.50 $0.00 DOOR/WINDOW; 101-0000-42400 0 $60.91 $0.00 REPLACE FJRST 7 DOOR./WINDOW, 101-0000-42600 0 $110.22 $0.00 REPLACE, FIRST 7 PC Total Paid for WINDOW/SLIDING GLASS $171.13 $0.00 DOOR/FENESTRATION: TOTALS:• •• PARENT PROJECTS BONA INFORMATION Printed: Wednesday, February 10, 2016 10:03:19 AM 2 of 2 C .SYSTEMS STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CEC-CFIR-ALT-01-E Revised 06/14 CERTIFICATE OF COMPLIANCE Prescriptive Residential Alterations Proiect Name: CALIFORNIA ENERGY COMMISSION C F 1 R -ALT -01- E (Page 1 of 4) Date Prepared: A. GENERAL INFORMATION 01 , 01 Project Name: j,, ,. r- _— 02 Date Prepared: - 03 Project Location: 04 Building Front,Cipentatior (deg or cardinal): 05 CA City: C 06 Number of Alt red'O ellfng Units: eovk 07 Zip Code: Ct 08 Fuel Type: k ,� *.A*,. `v' 09 Climate Zone:10 T,otal,Con�dltioned Floor -,Area (fE2).-'1 11 1 Building Type 12 1 Slab.;,krW ft2) 13 1 Project Scope: Q Reflectance Reflectance Emittance (Optional) Reflectance Emittance (Optional) i l R v 11 . ' V. B: BUILDING INSULATION DETAILS (Section 1s0.2(b)1) 4. 01 02 03 04 05 06 O„n S,,e''y07 I 08*flV.Q9 10 11 Tag/ID Assembly Type „r Frame Type Frame Depth I (inches) Frame Spacing I (inches) roposed ' Required Comments " ` Continuous CavityInsulation R -value, R -value > U -factor ti4gAppendix JA Reference LI -Factor Table, Cell Deck Compliance Pitch Exception (Number ,FoductTypey_ , Insulaedo Reflectance Reflectance Emittance (Optional) Reflectance Emittance (Optional) C. ROOF REPLACEMENT (Prescriptive Alteration, S ion*150.2(b)1H) V 01 02 03 04 05\, 06 °077# 08 09 10 11 12 13 R -value Propos d Minimum Re uired Initial Solar Aged Solar Thermal SRI Aged Solar Thermal SRI Method of Roof CRRC oduct ID Deck Compliance Pitch Exception (Number ,FoductTypey_ , Insulaedo Reflectance Reflectance Emittance (Optional) Reflectance Emittance (Optional) NOTES • Roof area covered by building-ntegrated photovoltaio-panels and solar thermal panels are exempt from the above Cool Roof requirements. • Liquid field appliedcoatings-must comply witfi stallation criteria from section 110.8(i)4. V ' Registration Number: Registration Date/Time: HERS Provider: CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014 STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CEC-CFIR-ALT-01'-E Revised 06/14 CERTIFICATE OF COMPLIANCE Prescriptive Residential Alterations Proiect Name: D. FENESTRATION/GLAZING AREAS ALLOWED (Section 150.2(b)1) 01 02 03 Alteration Type _ Orientation Maximum Allowed ft2 E. FENESTRATION/GLAZING PROPOSED AREAS AND EFFICIENCIES (Section 150.2(b)] 01 02 03 04 05 06 07 0„8 Tag/ ID Fenestration Type Frame Type Dynamic Glazing Orientation N, S, W, E, or Roof Area Removed ft2 Area Added ft2 ro� Net Added Area ft2 La a Net Added Wesla i Fenestration,A'�a a b Existing+ AddedW's"tfacing FengstratinpAr, a c Maximum Allowe� West-faciggQ mer nation Area ry d Is West -facing Fenestration Area < Miv— iv,ximumAllowed West. Ir'jg Fenestration "Area, e6 _ N;et Added Fenestration Area (all or,�'en�tations) f Existing + Addded;Fennestration Area (al'�o(iAhtations) g `' Maximum+Allllo !Fewhestration Area (all oi6tations) h .? n ti , y Is Existing + gd,�dedxFenestration Area c'fvlaximum Allowed Fenestration Area (all orientations) Registration Number: Registration Date CA Building Energy Efficiency Standards - 2013 Residential Compliance IA ENERGY COMMISSION CFIR-ALT-01-E (Page 2 of 4) Date Prepared: IDENTIAL ALTERATIONS. CEC-CF;I R -ALT -OT -E Revised 08/14. " CERTIFICM.C►F CONIP..L'IAN:CE Prescri.ptiue Resldentlal Alterations Project Name: CFIR-ALT-01-E (Page 2 df 4), Date Prepared: D. FENESTRATION/GLAZING AREAS ALLOWED Section 150.2 b 1 04 .01...: `.`:°Alteration T a Orientation" Maximum'Allowed ft2 Coinrrr).erits. v . & E FENESTRATION/GLAZING PROP08ED AREAS AND EFFIC)ENCIES (Sectioii'150.2(b)1) ... ,... .. ...„.. �ifiw .,>.b. '?i_ .�........ .. _: .....r.:•a .�., . K Ol 02 :, 03 : 04 05 06 :: 07, OS A. W 9 >° .: ;..,.1i 12 13 14 ls::..:: :...� Combined ',,.'-.Tag/! 'F"rame Orientation , Area Area Net dried Maxmt Exterior Shading SHGC from Fenestration Dynamic N, 5 W, E, or Removed Added A d �., 'r ., r;F:• fi e .. `... GlBzmg. nRoof ft2 .> .” ft ;_: .: Area ft2 a" .vUrfactor` Source a-SHGC::. S.o.urce.. . ,.Device Ulll-ENV-03 6.<::23 ..:....:.... 23. .5.....::i a,..� Net Added, We enestrat�on.ai a > M"rOAreb b Existing + Add. eclNs;facing Fentrat �t F - Maximum ":West-facl er s tion Area dIs e •. dla Vl/est facing Fenestration Area <� A 'Allowed W Fenesttetlo .. „� :......, t'Added Fen stra o rea','e dtiorr�j`: ONO (all o . - ilex#ting+ Adde"d Ez, anon Area (ai4iiestations) >> ; , <-..., Maximum At)q nesttallon Area (all orl'entations) ....,.. ..,:... . - Existirg+e�finestration Area < azimum Allowed Fenestration Area:(all ':;:,.,..,:.•.,,::::,. orientations HERS Provider: June 2014 ► STATE OF CALIFORNIA. RESIDENTIAL ALTERATIONS CEC-CFIR-ALT-01-E Revised 06/14 r` CERTIFICATE OF COMPLIANCE Prescriptive Residential Alterations Proiect Name: CFIR-ALT-01-E (Paee 3 of 41 Date.Prepared: F. SPACE CONDITIONING(SC) SYSTEMS — HEATING/COOLING (Prescriptive section 150.2(6)) 01 02 03 Dwelling Unit Name Dwelling Unit CFA (Ft2) Com nts .. Q,441161 �a a 'D G. WATER HEATING SYSTEMS (Section 150.2(b)1G) 01 02 03 04 05 06 07 08 Q9x ~10 X11 P —12 13 14 15 Water Heating Water Heating Alteration to the Space q of Water (ft2) ._. i W me g ,Identification or Name 6 Comments i� Water Heater VHe tting Back -Up System Water Water Heaters Storage Rated Rated Heating Exterior Solar Dwelling Unit DHW Identification or Heating Heater in Volume Fuel Input EfficiencyVlffitiienc7;R.y Standby Insul. savings Central DHW System System Name System Type Type system (gal) Type Type, A Value TypedValue Lowes,.(%) R -Value Fraction Distribution Type Distribution Type H. SPACE CONDITIONING SYSTEMS AND WATER HE G SYSTEMS IN<MULTIFAMILY-DWELLING UNITS 01 02 03' 0'4 05 06 Centr%I Wa%4011eating en D�w,elling Unit System Dwelling Unit: Dwelling Unit Total'GFA System f' ification or.. . Water Heating Alteration to the Space Dwelling Unit Name (ft2) ._. i W me g ,Identification or Name Conditioning System(s)? Comments i� ON .1tv, k\4A 6 .0 Registration Number:. Registration Date/Time: HERS Provider: CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014 STATE OF CALIFORNIA . RESIDENTIAL ALTERATIONS .CEC-CFIR-ALT-01-E Revised 06/14 + CERTIFICATE OF COMPLIANCE Prescriptive Residential Alterations Proiect Name: Date Prepared: C'F 1 R -ALT -01-E (Pave 4 of 41 DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. I certify that this Certificate of Compliance documentation is accurate and complete. . Documentation Author Name: Documentation Author Signature: Company: Signature Date: Address: '• CEA/HERS Certification Id2-tiicattoonl(ifapplicable) : --t-sem• City/State/Zip: Phone: RESPONSIBLE PERSON'S DECLARATION STATEMENT- 41, I certify the following under penalty of perjury, under the laws of the State of California: 1.. The information provided on this Certificate of Compliance is true and correct. buildirg design 2. 1 am eligible under Division 3 of the Business and Professions Code to accept respons• IIIty for the desg or system identified on this Certificate of Compliance (responsible designer). 3. That the energy features and performance specifications, materials, componen and manufacturre d! ices for the building design or system design identified on this Certificate of Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of'Regulatlons. pliance information documents, 4. The building design features or system design features identified.on this Certificate of Co" acre consistentw�tsa;he provided on other applicable compliance ement iy^fo with bu ding worksheets, calculations, plans and specifications submitted ,to the'"e'nfor age approval this permit application. 01 U 5. 1 be v ble�with the bu'Idli pgrmrt(s) issued for building, to the will ensure that a registered copy of this Certificate of Corrtpliancetshall made the and made available enforcement agency with building for all applicable inspections. I, understand that a registered a spy of this Certificate oaf Compliance is req red'to be included the documentation the builder provides to the VK owner at occupancy. , Responsible Designer Name: Respacsible Designer Signature: Company :% L°Y�s .y .. .. .�. PO:q 6* Dite Signed: Address: License: City/State/Zip: coo Phone: For assistance or -questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300. Registration Number: Registration Date/Time: HERS Provider: CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014 6 ; <0 I j: -JQ r rl a'n # City of La Q uin to Building & Safety Division . . 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: 5.Rowner's Name: A. P. Number: Add ess: S;)L —1 l e Z NY Le al Description: plZZS3TC,+T,Zip: ntra ct r Ca o. Tlehn• e o e. A i 100 3 3 Address: Sa L( -Project Description:me " h City, ST, Zip: Q, • Z +Q • Telephone: C P S State Lie. # : City Lie. #t Arch., Gngr., Designer: Address: City, ST, Zip: Telephone: one:Occupancy: Con truction TY Pe: State Lic. # ddn Alter Repairair Demo o Project (circle one): New A Nameof Contact Person: r Sq. Ft.:# Stories: #Units: Estimated Value of Project: Telephone # of Contact Person: �Z APPLICANT: DO N07 WRITE BELOW THIS LINE ' # Submittal Req'd Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. i Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2nd Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. II.O.A. Approval Plans resubmitted Grading IN If OUSE:- Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees, Total Permit Fees 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 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 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. 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 -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 -Builder" building permit which erroneously implies that the property owner is providing his or her own labor and material personally? Did you know — your homeowner's insurance may not provide coverage for injuries sustained on your property by an unlicensed contractor and his/her employees? Did you know — if you are considered an "employer" under state and federal law, you must register with the state and federal government, withhold payroll taxes, provide workers compensation and disability insurance and contribute to unemployment compensation for each "employee"? Did you know — that if you fail to abide by these laws you may be subjected to serious financial risk? . OWNERS BEWARE AND CONSIDER THE RISK BEFORE ACCEPTING FULL RESPONSIBILITY FOR YOUR CONSTRUCTION PERMIT ,•P P.'O. Box 1504 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 buijdU permit s beenub ed in yRur name }istmg ourself as jke builder of the property improvements specified at y it ( Ln, ;, 3 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. Read and initial each statement below to signer 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" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property: My homeowner's insurance may not provide coverage for those inj es. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers n property. I understand building permits are not required to be signed by property owners unless they are responsible for the F"truction 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. I understand that I may protect If from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on and contracts. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" state and federal law. `�14 / '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 4s7 nation for each "employee." I also understand my failure to abide by these laws may subject me to.serious financial Iunderstand under California Contractors' State.License Law, an Owner -Builder who builds single-family residential es cannot legally build them with the. intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any fi ncial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the tsrvice, manship or materials. 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue 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- 8 0-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors. 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the all an fmanc- 11 onsi 1g for pr posed construe on activity at the following address: �11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all qa pli 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 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 responsibj&lgr issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification accgpt�ab \to tJ agency * q�F ed to be presented when the permit is issued to verify the property nre owner's signature. �� \\ Signature of property owner % Date: Z- kV I to Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): Project Location or Address: Name of Authorized Agent: 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 to be presented when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: