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BPLB2019-0045U� VOICE (760) 777-7125 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 3/27/2019 Permit Type/Subtype: PLUMBING/ Owner: Application Number: BPLB2019-0045 MCWILLIAMS, BRUCE & DEBRA Property Address: 49650 COACHELLA DR 79650 COACHELLA DR. APN: 646230002 LA QUINTA, CA 92253 Application Description: MCWILLIAMS / 50 GALLON WATER HEATER CHANGE OUT Property Zoning: Application Valuation: $700.00 Applicant: Contractor: MCWILLIAMS BRUCE & DEBRA � i OWNER BUILDER 79650 COACHELLA DR. ,h R n 7 3 MAR ,rd LA QUINTA, CA 92253 CITYORAQUINTA Llc. No.: LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 {commencing with Section 70001 of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: License No.: 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 ( 00).: ( I as owner of the property, or my employees with wages as their sale t pensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that e or,ske did not build or improve for the purpose of sale.). ( I, as owner of the property, am exclusively contracting with licensed contractors to c nstruct 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. fort is reason Date: I 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' _ 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: Carrier: Policy Number: I certify that in the performance of the work for which this permit is issued, shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application , the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above -mentioned property for inspection purposes. /_ A Date: 3 IfIf I Signature (Applicant or Agent): Lender's Add Application Number: BPLB2019-0045 Property Address: 49650 COACHELLA DR APN: 646230002 Application Description- MCWILLIAMS / 50 GALLON WATER HEATER CHANGE OUT Property Zoning: Application Valuation: $700.00 Applicant: MCWILLIAMS, BRUCE & DEBRA 79650 COACHELLA DR. LA QUINTA, CA 92253 Owner: MCWILLIAMS, BRUCE & DEBRA 79650 COACHELLA DR. LA QUINTA, CA 92253 Contractor: OWNER BUILDER Llc. No. Date: 3/27/2019 Detail: 50GALLON WATER HEATER CHANGE OUT [GAS] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2016 CALIFORNIA BUILDING CODES. DESCRIPTION ACCOUNT CITY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT CITY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $101.40 Total Paid for PERMIT ISSUANCE: $101.40 DESCRIPTION ACCOUNT CITY AMOUNT WATER HEATER/VENT 101-0000-42401 0 $13.34 DESCRIPTION ACCOUNT CITY AMOUNT WATER HEATER/VENT PC 101-0000-42600 0 $8.00 Total Paid for PLUMBING FEES: $21.34 DESCRIPTION ACCOUNT CITY AMOUNT RECORDS MANAGEMENT FEE 101-0000-42416 0 $10.00 Total Paid for RECORDS MANAGEMENT FEE: $10.00 DESCRIPTION ACCOUNT CITY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 STATE OF CALIFORNIA Prescriptive Residential Alterations That Do Not Require HERS Field Verification CEC-CF1 R-ALT-05-E (Revised 04116) CERTIFICATE OF COMPLIANCE - - - Prescriptive Residential Alterations That Do Not Require HERS Field Verification Pmiect Namd war. This compliance document is only applicable to simple alterations that do not require HERS verification for compliance. When with a HERS Provider Data Registry. ENERGY COMMISSION CF111-ALT-05-E Page 1 of 3 is required, a CF1R-ALT- 01 shall first be registered Afterotions to Space Conditioning Systems shot ore exempt from HERS verification requirements may use the CFIR ALT-05 and CF2R-ALT 05 Compliance Documents. Possible exemptions from duct leakage testing include: less than 4o ft of ducts were added ar replaced, • or the existing duet system was insulated with asbestos; or the existing duct system was previously tested and passed by a HERS Rater. If space conditioning systems are altered and are not exempt from HERS verification, then a CF1R-ALT-02 must be completed and registered with a HERS Provider Data Registry. Alterations that utilize close Cell Spray Polyurethane Foam (ccSPF) with a density of 1.5 to less than 2.5 pounds per cubic foot having an R-value other than 5.8 per inch, or Opel: Cell Spray Polyurethane Foam (ocSPF) with a density of 0.4 to less than 1.5 pounds per cubic foot having an R-value of 3.6 per inch, shall complete and register a CFIR-ALT-01 with a HERS Provider Data Registry. If more than one person has responsibility for installation of the items on this certificate, each person shall prepare and sign a certificate applicable to the portion of construction for which they are responsible. Alternatively, the person with chief responsibility for construction shall prepare and sign this certificate for the entire construction. All applicable Mandatory Measures shall be met. Temporary labels shall not be removed before verification by the building inspector. A. General Information -- 01 Project Name: 02 Date Prepared: 03 Project Location:- ,� 04 Building Front Orientation (deg or cardinal): 05 CA City: . 06 Number of Altered Dwelling Units: 07 Zip Code: 08 Fuel Type: 09 Climate Zone: j 10 Totakonditianed Floor Area (ft): 11 Building Type: 12 Slab Area (ft) 13 Project Scope (Select all that apply): ❑ B. Insulation ❑ D. & E. Fenestration/Glazing - ADD ❑ G. Space Conditioning System (Heating, Cooling, Duct system) ❑ Lighting ❑ C. Roof Replacement ❑ D. & F. Fenestration/Glazing - REPLACE ❑✓ H. Water Heating System ❑ Include Mandatory Measures? CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016 STATE OF CALIFORNIA Prescriptive Residential Alterations That Do Not Require HERS Field Verification CEC-CFIR-ALT-05-E (Revised 04116) CERTIFICATE OF COMPLIANCE Prescriptive Residential Alterations That Do Not Require HERS Field Verification CALIFORN MMISSIONE CFIR-ALT-05-E Page 2 of 3 FI. Water Heating Systems (Section 150.2(b)1G) _ 01 02 03 04 05 06 07 08 09 10 11 12 13 14 1l15 # of Water Water Heating Heating System Water Heaters Water Heater Rated Heating Heating Exterior I Back -Up Solar Dwelling I System Location or Water Heating Water In Storage Fuel i Rated Input Efficiency Efficiency Standby Insulation, Savings Unit Name ID or Name Area Served System Type Heater Type System Volume (gal), Type I Input Type Value Type Value Loss (%) I R-Value i Fraction I. C��T�GS - 4�v _6c,5 1'uw I -Row 13T� Add pvlew Row CA Building Energy Efficiency Standards - 2016 Residential Compliance April 2016 STATE OF CAUFORNIA !!! Pre riptke Residential Alterations That Do Not Require HERS Field Verification CEC-CFtR-ALT-M-E {Rewsad o4MR) CERTIFICATE OF COMPLIANCE - — - - - — - Prescriptive Residential Alterations That Do Not Require HERS Field Verification DOCUMENTATION AUTHOR'S DECLARATION STATEMENT 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. Documentation Or Name: ,/�,� -ompany: Do[u �a w. ClO /ioSb Coc.`kt II Signa 7ddress: _ `— nature, 2"1 f �24c MMISSION MR-ALT-05-E Page 3 of 3 Phone: RESPONSIBLE PERSON'S DECLARATION STATEMENT 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. 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsibility for the building design or system design identified on this Certificate of Compliance (responsible designer). 3. That the energy features and performance specifications, materials, components, and manufactured devices 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 Regulations. 4. The building design features or system design features identified on this Certificate of Compliance are consistent with the information provided on other applicable compliance documents, worksheets, calculations, plans and specifications submitted to the enforcement agency for approval with this building permit application. 5. 1 will ensure that a registered copy of this Certificate of Compliance shall be made available with the building permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand that a registered copy of this Certificate of Compliance is required to be included with the documentation the builder provides to the building owner at occupancy. Responsible Designer P&kre+r— ^ - rn' r Responsible Designer Signature: COfISPan v 6 Ga C. C7—s'� ense: one: 2-7 For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300. CA Building Energy Efficiency Standards - 2016 Residential Compliance — — -- — — — April 2016 BRADFQRD MITE® W A T E R H E A T E R S Residential Atmospheric Vent Gas Water Heater _Jkl 106 { Photo is of RG240T6N FEATURING: ICON —System Aaa 0 ' �YCJ l7LYE'L�M1J The Atmospheric Vent FVIR Defender Safety System® Models Feature: ■ Bradford White ICON System®* —Intelligent gas control with proven millivolt powered technology and built-in piezo igniter. A standard, off -the -shelf thermopile converts heat energy from the pilot flame into electrical energy to operate the gas valve and microprocessor. No need for external electricity. — Enhanced Performance —Proprietary algorithms provide enhanced First Hour Rating and tighter temperature differential. — Advanced Temperature Control System —Microprocessor controls burner operation for consistent and accurate water temperature levels up to 160'F (71 *Q. — Intelligent Diagnostics —Exclusive multicolor LED light indicates operation status/service required. ■ Advanced ScreenLok® Technology Flame Arrestor Design —Flame arrestor is designed to prevent ignition of flammable vapor outside of the water heater. E Resettable Thermal Switch —Proven and reliable bimetallic switch prevents burner and pilot operation in case of ongoing flammable vapors burning inside of the combustion chamber or restricted air flow. ■ Maintenance -Free —No regular cleaning of air inlet openings or flame arrestor is required under normal conditions. ■ Sight Window —Offers a view into the combustion chamber to observe the operation of the pilot and burner. ■ Factory -Installed Hydrojet' Total Performance System --sediment reducing device that also increases first hour rating of hot water while minimizing temperature build-up in tank. • Vitraglas® Lining —An exclusively engineered enamel formula that provides superior tank protection from the highly corrosive effects of hot water. This formula (Vitraglas) is fused to the steel surface by firing at a temperature of over 1600°F (871-Q. ■ Insulation System—Non-CFC foam covers the sides and top of the tank, reducing heat loss. This results in less energy consumption, improved efficiencies, and jacket rigidity. ■ Pedestal Base. • Water Connections--,V4" (19mm) NPT factory installed true dielectric fittings. ■ Factory -Installed Heat Traps. ■ Protective Magnesium Anode Rod. ■ 3x4 "Snap Lock" Draft Diverter—Allows either 3" (76mm) or 4" (102mm) vent connections with inputs of 40,000 BTU/Hr. or less. Over 40,000 BTU/Hr. has the 4" (102mm) "Snap Lock" Draft Diverter. ■ T&P Relief Valve —Installed. ■ Low Restrictive Brass Drain Valve —Durable tamper proof design. ■ NOx Emissions —Less than 40 ng/J. `May vary by region 6 or 10-Year Limited Tank Warranties / 6 or 10-Year Limited Warranty on Component Parts. a ��1 For more information on warranty, please visit co. Some states For products installed in USA, Canada, and Puerto Rico. Some states do not allow limitations on warranties. See complete copy of the warranty included with the heater. MANUFACTURED UNDER ONE OR MORE OF THE FOLLOWING U.S. PATENTS: 5,682,666; 7.634,976; 5.660.165; 5,954,492; 6.056,542; 6.935,280; 5,372,185; 5.485,879; 5,574,822; 7,971,560; 7,992,526; 6,684,821; 7,334.419; 7,866,168; 7,270,087; 7,007,748; 5,596,952; 6,142,216; 7,699,026; 5,341,770; 7,337,517; 7.665,211; 7,665,210; 7,063,132; 7.063,133; 7.559,293; 7,900.589; 5.943,984; 8,082.888; 5.988,117; 7,621,238; 7.650.859; 5.761,879; 7,409,925; 5,277,171; 8,146,772; 7.458.341; 2,262,174- OTHER U.S. AND FOREIGN PATENT APPLICATIONS PENDING. CURRENT CANADIAN PATENTS: 2,314,845; 2.504,824: 2,108,186; 2,143,031; 2,409,271; 2.548,958; 2,112,515; 2,476,685; 2,239,007; 2.092,105; 2,107,012, Defender Safety System-, ScreenLokm, Vitraglas° and Hydroiet' are registered trademarks of Bradford White* Corporation. 1101-B-091a r Residential Atmospheric Atmospheric Vent Models NATURAL GAS AND LIQUID PROPANE GAS Vent Gas Water Heater Meet or exceed ASHRAE 90.1b (current standard) C.E.C. Listed Recovery efficiency ranging up to 80% Model Number Nominal Gal. Capacity U.S. Imp. Gal. Gal. DOE Rated Slorage Volume (Gal,) LP BTU/Hr. BTU/W. input Input First Hour RaUn (Gala Uniform Energy Factor Recovery at Model 90°FRlte' Numher LP LP U.S. Imp. U.S. Imp, GPH GPH GPH GPH Nominal Liter Capacity DOE Rated Storage Volume (Lilers) LP kW kW Input input First Hour Rating (Ulars) Uniform Energy Factor Recovery at 50'C111e' LP Literal Liters/ Hour Hour F 09T6N■ 30 25 29 27.000 27.000 46 0.54 29 24 29 7z RG13MN9 114 1111 1 7.9 7A 174 0.54 110 Ila RG230TfiN• 30 25 29 1 32,000 31,000 60 0.60 34 28 33 23 RG230T6N• 114 110 1 9.4 9.1 227 0.60 129 125 RG23056N 30 25 29 30.000 32,000 49 0.54 32 37 32 27 RG230S6N 114 110 8.8 9.4 186 0.54 121 121 RG140T6N• 40 33 38 34,000 34.000 64 0.59 37 31 37 31 R5140TWI, 151 144 10.0 9.9 243 0.59 139 139 RG240T6119 40 33 38 40,000 36.000 75 0.64 43 36 34 33 RG240T6N• 151 144 11.7 10.6 284 0.64 163 129 RG24056N9 40 33 38 40,600 35.000 69 058 43 36 41 34 RG240S6N• 151 144 11.7 10.3 262 0.50 163 155 MG150T61119 50 42 47 34,060 34,000 75 D.63 37 31 37 31 iaGt5OT6N■ Tg 178 10.0 9.9 284 0.63 139 139 RG250TSN4 1 50 42 48 40,000 35,000 81 0.63 43 36 41 34 RG250T6N• 189 182 11.7 10.3 307 0.63 163 155 RG250L6N 48 40 47 40.000 35,000 77 0.63 j 43 36 41 34 RG25OL614 1 182 1 178 1 11.7 10.3 292 D.63 163 155 FIG250S6N■ 1 50 42 1 47 1 50,000 48.000 75 1 0.63 1 54 45 52 45 RG250SMV 1 189 1 178 1 14.7 14.1 1 284 0.63 294 197 Model Number A Floor to Exhaust Conn. in. B Jackal Dia. In. C Vent Size In. 0 Floorlo TAP Conn. In. E Floorlo Gas Conn. in. F Floor to Top of Healer in, G Floor to Water Conn. in. H Depth In, J C/Lat Water Conn. in. M Water Conn. NPT In, S Gas Conn. Size in, Approx. Shipping Weight lbs. 116730T6Ne 5911, i8 3or4 4924 13 561/4 57 1911? 8 3/4 .1, 10b RG23OT6N• 593/4 18 3or4 493/4 13 561/4 57 211/2 8 3/4 1h 116 116230SM 491/4 20 3or4 387/8 13 45314 46112 231h 8 3/4 1/2 113 RG140T6N9 615/15 18 3or4 515/9 13 5713h6 599h5 21112 a 31, 1h 132 AG240TBN• 6011s 20 3or4 493/4 13 5651s 57a/s 231h a al4 1/2 134 RG240S6N9 519/16 22 3 or 4 4111% 13 481/16 4813hs 251h 8 3/4 flz 139 RG150T6118 601A 20 3or4 4911116 13 565/0 5731e 231/2 8 a/4 qz 148 f1G2SDT6N6 601/8 22 3or4 4915h6 13 56518 573/e 251/2 8 3I4 11, 154 RG2501.6N 51 M6 24 1 3 or 4 1 4011/16 13 481h5 4811/1s 271/2 8 1 11+ 1 1h 170 RG250S6116 601/e 1 22 1 4 1 4915h6 13 565/s 573/s 1 25112 8 1 314 1 1/2 167 Model Number A Floorlo Exhaust Conn. mm. B Jackal Dla. rem. C Vent Size mm. D Floorlo TAP Conn. mm. E Floor to Gas Conn. mm. F Floorto Top of Heater mm. G Floor to Water Conn. mm. H Depth mm. J CILat Water Conn. mm. M Water Conn. NPT mm. S Gas Cann. Size mm. Approx. Shipping Weight kg. R'G130T6N9 1518 406 76or102 1264 330 1429 1448 495 203 19 13 48 RG230T6N9 1518 457 76or102 1264 330 1429 1448 546 203 19 13 53 RG230S6N 1251 508 76or102 987 330 1162 fiat 597 203 19 13 51 R8140T09 1557 457 76or102 1311 330 1468 1513 546 203 19 13 60 RG240T6N6 1527 508 76 or102 1264 330 1438 1457 597 203 19 13 61 RG240S60 1310 559 76or102 1043 330 1221 1240 648 203 19 13 63 RG15016N• 1527 508 76or102 1268 330 1438 1457 597 203 19 13 67 RG250T6Ne 1527 559 76or102 1268 330 1438 !457 648 203 19 13 1 7O RG250LSN 1310 1 610 76or102 1033 330 1221 1240 699 203 19 13 1 77 13C?50S6N• 1527 1 559 102 1 1268 330 1438 1457 648 203 19 13 1 76 Propane models feature a Titanium Stainless Steel propane burner. For Propane (LP) models change suffix "N" to 1C. For 10 year models, change suffix from "6" to "10". Based on manufacturer's rated recovery efficiency. _ • Models feature optional top T&P location and must be specified when ordering. Note: RG23OS6N and RG250L6N do not have top T&P option. Uniform Energy Factor and First Hour Rating is based on the latest AHRI directory listings. General: Meets NAECA Requirements. All gas water heaters are certified at 300 PSI test pressure (2068 kPa) and 150 PSI working pressure (1034 kPa). All water connections are a/" NPT (19mm) on 8" (203mm) centers. All gas connections are W" (13mm). All models design -certified by GSA International (formerly AGA/GGA), ANSI standard Z21.10.1 and peak performance rated. Dimensions and specifications subject to change without notice in accordance with our policy of continuous product improvement. Suitable for Water (Potable) Heating and Space Heating. Toxic chemicals, such as those used for boiler treatment, shall NEVER be Introduced into this system, This unit may NEVER be connected to any existing heating system or component(s) previously used with a non -potable water heating appliance. Optional Top T&P Valve - ereaoFaan wllrre,s- For field service, contact your professional installer or local Bradford White sales representative. 4W Sales 800-523-2931 ■ Fax 215-641-1612 AMU RICAN 18RADFG*0 SWITE" Technical Support 800-334-3393 ■ Email techserv@bradfordwhite.com STRONG. ` Ambler, PA Warranty 800-531-2111 a Email warranty@bradfordwhite.com International: Telephone 1-215-641-OW ■ Email i atfonal@,hradfordwhite com / www.bracffonMhite.com Built to be the Best" 1101-13-0918 02018, Bradford White Corporation. All rights reserved. Printed in U.S.A. � � r P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLS 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: Hizhcst 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 Sienilicant 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 Sienificant 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 cei4, 4 .fwa" 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 bee s bpritted in your name li tin yourself as the builder of the property improvements specified at 41 95 0 C 0 tk - We are providing you with an Owner -Builder Acknowledgment and Information Vertfr ation 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. L-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. 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. U2. 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. "j73. 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. kq- I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on tpermits and contracts. nn Yam. 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" under state and federal law. l 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 risk. W".. 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. L. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 4-9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. -R=W. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: �j �►n, I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as well as employers. I . agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a 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 ag ncy 's required to be presented when the permit is issued to verify the property owner's signature. Signature of property owner _ Date: Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the properly 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 K 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: 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 verify the property owner's signature. Property Owner's Signature: Date: rrQUiKra — b, UISPKF — PERMIT # dB?LPZ Wt 1 60* 00Vr PLAN LOCATION: ProjectAddress: L.I9 6 �—Q / L Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech APN #: �,� eCAI Applicant Name-7,�L}xz Address: y q G �O c00. C t%f,' City, ST, Zip: ' Telephone: � p Email: [� �� t ` I ` Valuation of Project $ 7C0 v0 opi Contractor Name: New SFD Construction: Address: �wl.y 1 L� Conditioned Space SF City, St, Zip Garage SF Telephone: Patio/Porch SF Email: Fire Sprinklers SF State Lic: City Bus Lie: Arch/Eng Name: Construction Type: Occupancy: Address: Grading: City, St, Zip Telephone: Bedrooms: Stories: # Units: Email: State Lie: City Bus Lie: Property Owner's Name: P3V, �c" w6 `L� New Commercial / Tenant Improvements: Address: cal G T—) l Total Building SF City, ST, Zip 1.4, � Construction Type: Occupancy: Telephone: l (� — (� UL� Email: 78495 CALLE TAMPICO LA QUINTA, CA 92253 760-777-7000 `moo -- r I os gjqe