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BPLB2018-016078-495 CALLE TAMPICO D 'iCIJ LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Permit Type/Subtype: PLUMBING - SEWER CONNECT/SEPTIC ABANDON (WEB)/ Application Number: BPLB2018-0160 Property Address: 50795 CALLE RONDO APN: 770101004 Application Description: GOETSCH / SEPTIC ABANDONMENT SEWER CONNECT Property Zoning: Application Valuation: Applicant: D BRETT ROLAND GOETSCH 50795 CALLE RONDO DEC 2 1 2018 LA QUINTA, CA 92253 CITY OF LA QUINTA DESIGN & DEVELOPMENT DEPARTMENT 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 all ed exemption. Any violation of Section 7031.5 by any applicant for a permit u is the applicant to a civil penalty of not more than five hundred dollars ($500).: Was owner of the property, or my employees with wages as their sale flmpensation, 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 wit 'n 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.). s. as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Set. 7044, Business and Professions Cade: 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 reas4V Date: / /O' 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 Name. Lender's VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/21/2018 Owner: BRETT ROLAND GOETSCH 50795 CALLE RONDO LA QUINTA, CA 92253 Contractor: OWNER BUILDER - SEE CONTACTOR SUB LIST Llc. No.: WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 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: Car Policy Number:_ stm1 certify that in the performance of the work for which this permit is issued, I mploy 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 e, I shall forthwith comply with those provisions. Date: Z r �(� v Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENS TION 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 relating5tq building construction, and hereby authorize representatives c ity to enter upo a ab e- mentioned property for inspection purposes. Date-2,_ Signature (Applicant r r bate:' 12/21/2018 Application Number: Property Address: APN: Application Description: Property Zoning: Application Valuation: Applicant: BRETT ROLAND GOETSCH 50795 CALLE RONDO LA QUINTA, CA 92253 BPLB2018-0160 50795 CALLE RONDO 770101004 GOETSCH / SEPTIC ABANDONMENT SEWERACONNECT Owner: BRETT ROLAND GOETSCH 50795 CALLE RONDO LA QUINTA,CA 92253 Contractor: OWNER BUILDER - SEE CONTACTOR SUB LIST Llc. No.. Detail: ABANDON SEPTIC TANK AND FILL WITH SLURRY OR SAND AND HOOK UP TO CITY SEWER. PER 2016 CALIFORNIA PLUMBING CODE FINANCIAL DESCRIPTION INFORMATION ACCOUNT CITY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $101.40 Total Paid for PERMIT ISSUANCE: $101.40 DESCRIPTION ACCOUNT CITY AMOUNT SEWER CONNECTION/SEPTIC ABANDON 101-0000-42401 0 $26.68 DESCRIPTION ACCOUNT CITY AMOUNT SEWER CONNECTION/SEPTIC ABANDON PC 101-0000-42600 0 $18.68 Total Paid for PLUMBING FEES: $45.36 DESCRIPTION ACCOUNT CITY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 I ta QU;Ara PERMIT # IJ D�— 0 (koc) PLAN LOCATION: j®79 j C_ SSG GOio Project Address: �07�p O��D Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech APN #: � T % 14han o Oo ln eo Applicant Name: ��d� V 0 e6 c, Address: P 7 9f ealle City, ST, Zip: 4? au w Telephone: Ito .O , 0-�75Y Email: gj, q Valuation of Project $ 1 , 0 (DO Ci Lu%ub L Contractor NamaeJ: S'c�� 1061�`i�lS�, 3utL�El'� 61 Address: 7✓ 4 �) - ,(lr . JUt jL Z- X z city, st, zip Al. Pse(.� 8 Telephone: Email: State Lic: 9fo0-7-yV City Bus Lic: d ($0(66 New SFD Construction: Conditioned Space _ SF Garage SF Patio/Porch SF Fire Sprinklers SF Arch/Eng Name: Construction Type: Occupancy: Address: Grading: City, St, Zip Telephone: Bedrooms: Stories: #Units: Email: State Lic: City Bus Lic: Property Owner's Name: &-e ff 6 (7 G New Commercial / Tenant Improvements: Address: 1Co 7 6 U (a Me— A0Ic/b Total Building SF City, ST, Zip iQ t1f;4 el� Construction Type: Occupancy: Telephone: YCO - L��j� 0-"5r: f y Email: l�IG7*@ Q7 e 60 " 78495 CALLE TAMPICO LA QU I NTA, CA 92253 760-777-7000 OFFICE USE ONLY # Submittal Req'd Rec'd Plan Sets Structural Calcs Truss Calcs Title 24 Calcs Soils Report Grading Plan (PM10) Landscape Plan Subcontractor List Grant Deed HOA Approval School Fees Burrtec Debris Plan Planning approval Public Works approval Fire approval City Business License 3 S��/'C fT Glr�Gir'7�'1 reel � r7 75--- Sewev— A4111 3-0-M, 5' Iql If FCITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION DATE ` `$ BY eam e.-e4e- v� 'p- r 7' �lq�ke� ray '�a�cr-Co. Si �FF_T (fai a) e .� C-,p\-u-E Ro�,�a - SITE REQUIREMEH.TS INTERIOR LOT SIDEYARD: S PEEN MP4MtTJM EACH SIDE FRON"iYARD: 20 FEET M494UM REAR -YARD: 10 FEET NUNIMUM 1 . I r - I • Z ' I . + 1 1 I • 1 1 1 1 i AREA TO 'BE 1 LMIDSWED i �-- PROPERTY • � LINES 1 CURBLINE ;NAT�R COACHELLA VALLEY WATER DISTRICT �757R�C+� P•O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 INVOICE Date:12/21/2018 SUBJECT: 50795 CALLE RONDO, LA QUINTA, LOT 30, SCC ONLY BRETT GOETSCH Project: 50-795 CALLE RONDO Project Date: Amount Due: LA QUINTA, CA 92253 GEO: Planner: TO INSURE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH REMITTANCE AND INCLUDE THE PROJECT ON YOUR CHECK SUBJECT: 50795 CALLE RONDO, LA QUINTA, LOT 30, SCC ONLY 18-9519 12/21/2018 $4,851.00 06-07-06-1 SARA LOPEZ COACHELLA VALLEY WATER DISTRICT P.O. BOX 1058, COACHELLA, CALIFORNIA 92236 (760) 398-2651 Pagel � CITY OF LA QUINTA SUB -CONTRACTOR. LIST JOB ADDRESS 5 �� �,4� PERMIT NUMBER _ OWNER Oe-e# 6 e— -BUILDER— 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 ❑ermit. For each aoi)licable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. T:r.a.de../ Classification Contractor State Contractor's License Workers Compensation insurance . City:B.usin.e.ss..Lice.nse Company Name Classification (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK (:C-12) �fV�l G'►r CONCRETE (C-8) FRAMING (C-5) STRU.CT.STEEL IC:=5'11 MASONRY (C-29) - PLUMBING (C-3.6) LATH, :PLASTER:(:C-3:5) DRYWALL (C-9) HVAC (C-20) ELECTRICAL (C-10.) ROOFING (C;M SHEET .METAL (C-:43Y FLOORING (C-15) GLAZING (C-17) INSULATION (C-2) SEWAGE DISP.:(C-4:2): PAINTING (C-33) ;ERAMIC TILE: (.C-54:) CABINETS iC-6I FENCING (C-13) .LAND .!CAPING:(C-27) POOL. (0-53) P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORN-IA 92253 BUILDING & SAFETY DEPARTMENT (760) 777 -7 012 FAX (760) 777-7011 Considering Becoming an Owner -Builder? STjUP 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 Sip_nificant Financial Risk Owner -as -Employer is a type of Owner -Builder where you pay any unlicensed individual to perform any construction work valued at more than $500.00, the permit is taken out in your name and you are personally responsible for their employment requirements, supervision, performance, safety and welfare while on your property. WARNING: Cost savings benefit can turn to serious financial risk if you fail to deduct payroll taxes or provide workers compensation insurance for each worker. Benefit/Risk: Possible Benefit with Significant Financial Risk (Health and Safety Code Section 19827) The California Legislature declares an "urgent and statewide public interest in assuring" that contractors comply with Contractors' License Law, Business and Professions Code and Workers' Compensation Insurance requirements to ensure property owners are informed about, and protected from the following when improving their property as Owner -Builders: Fraudulent representations - Liability for worker's injuries - Liability for material and labor costs unpaid by contractors • Licensing requirements • Employers tax liabilities Over 20,000 consumer complaints are filed each year. Many complaints relate to owner/builder projects and include workmanship and workers' compensation issues Homeowners suffer financial harm due to defective workmanship and injured employees. Following are alarming examples of what has occurred with Owner -Builder permits: Example 1: Homeowner received insurance money to rebuild burned -down home. • Owner/Builder permit pulled to rebuild structure. • Unlicensed contractor built substandard structure — must be torn down and replaced. • Estimated financial injury is $225,000. • Additional financial injury - IRS threatened to tax insurance payout if house not completed by the end of the year. Example 2: Brother-in-law had active license but filed an exemption from Workers Comp. • Owner -Builder hires brother-in-law to install a new roof. • Employee falls and sustains multiple spinal and extremity fractures as well as a head injury and remains in a coma to this day. • The Owner -Builder, who has sold the home, is now a defendant in a lawsuit for reimbursement for benefits paid to the injured worker. 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 Tiiy� 4 4 Q" 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 building permit has been submitted in your name listing yourself as the builder of the property improvements specified at 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 VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signs you understand or verb this information. t1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" uiing 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. tse 2. I understand building permits are not required to be signed by property owners unless they are responsible for the ruction 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 lf from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4, I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on ermits and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value o my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" id rsateand federallaw, 6. I understand ifI am considered an "employer" under state and federal law, I must register with the state and federal rnment, 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 ris . 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential s ctures 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. tan 8I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any cial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. V9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue elce, 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. It10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the legally and financially responsible for proposed construction activity at the following address: 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all app icable laws and requirements that govern Owner -Builders as well as employers. �612. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I e provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency 's required to be presented when the permit is issued to verify the property owner's signature. // Signature of property owner4 Date: /,?- I,7 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. i Scope of Construction Project (or Description o��f'W``ork): v s� fir �Lki2n - (60 �a ri13 � Project Location or Address: .�Ci�� l I,�[� Name of Authorized Agent: i/e 4 e t ' ` PL(Y 4 Tel No J �C ' 216 0 � Address of Authorized Agent:. 7 `' 6 Z'sAe /o 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 req ' • to be resent when the permit is issued to verify the property owner's signature. Property Owner's Signature: Date: , J47 Tikf 4 4 a" 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 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 Loss 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 Si2niiieant Financial Risk (Health and Safety Cade 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 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 building permit has been submitted in your name listing yourself as the builder of the property improvements specified at 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 VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signify 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" bui ding 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. OLI understand building permits are not required to be signed by property owners unless they are responsible for the o traction 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 m self from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on is and contracts. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" der state and federal law. V6. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal ve7rnunent, 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 risk. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential ctures 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. 'i' S. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any ancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. Y9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue ice, the [United States Small Business Administration, the California Department of Benefit Payments, and the California sion of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- Od-321 •CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the arty legally and financially responsible for proposed construction activity at the following address: 11. I agree that, as the party legally atfd financially responsible for this proposed construction activity, I will abide by all a piicable 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 1 1 ve 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 agency is r uired t be presented when the permit is issued to verify the property owner's signature. property Signature of owner ate: ` s 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. CITHORIZATION 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. rJ Scope of Construction Project (or Description of Work): 4-- � 1 c J Project Location or Address: / C Gt/C�iWoo 0 0 Name of Authorized Agent: + ,t Tel Not � 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 accurac . Note: A copy of th wner's driver's license, form notarization, or other verification acceptable to the agency ' eq ' e o be esented w the it is issued to verify the property weer' signature. Property Owner's Signature• ate: t