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BPOL2019-0077E 8-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Permit Type/Subtype: Application Number: Property Address: APN: Application Description: Property Zoning: Application Valuation: T-dyw .(,wQU;�rw DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT POOL/PRIVATE BPOL2019-0077 79734 N PARKWAY ESPLANADE 609610043 BOLUN / POOL AND SPA $20,000.00 Applicant: OVIDIU BOLUN 79734 PARKWAY ESPLANADE N LA QUINTA, CA 92253 QU�APR 14 2019 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 70001 of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: _ License No.: Date Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subj cts the applicant to a civil penalty of not more than five hundred dollars ($500).: as owner of the property, or my employees with wages as their sole ensation, 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 he did not build or improve for the purpose of sale.). 4 "a s owner of the property, am exclusively contracting with licensed contractors to PnuCt 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 or tractors' State License Law.). 1 am exempt under Sec. . B.&P.C. for this reason CONSTRUCTION ENDING 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: 4/25/2019 Owner: OVIDIU BOLUN 79734 PARKWAY ESPLANADE N. LA QUINTA, CA 92253 Contractor: OWNER BUILDER Llc. No.: WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Car 411', Policy Number:_ certify that in the performance of the work for which this permit is issued, I shamploy 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. r nTO WARNING: FAILURE TO SECUREi1NAL !PENALTIEtSAND RAGE I5 UNLAWFUL, AND SHALL SUBJECT AN EMPLOCIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF TH E 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. �dte:" igtfature (Applicant or Agent): Application Number: BPOL2019-0077 Property Address: 79734 N PARKWAY ESPLANADE APN: 609610043 Application Description: BOLUN / POOL AND SPA Property Zoning: Application Valuation: $20,000.00 Applicant: OVIDIU BOLUN 79734 PARKWAY ESPLANADE N. LA QUINTA, CA 92253 Date: 'VJ255 2019 Owner: OVIDIU BOLUN 79734 PARKWAY ESPLANADE N. LA QUINTA, CA 92253 Contractor: OWNER BUILDER Lic. No.; Detail: POOL, SPA IN REAR YARD [DENISE POELTLER ENGINEERING] NEW EQUIPMENT MUST BE LOCATED IN AN APPROVED LOCATION EITHER WITHIN THE REAR YARD SETBACK OR 5' MINIMUM FROM THE SIDE P/L--FIELD VERIFY. THIS PERMIT DOES NOT INCLUDE EQUIPMENT ENCLOSURE. ALARMS AND BARRIERS REQUIRED TO BE INSTALLED AT PRE -PLASTER INSPECTION.,!SP-H;CsIAL JN$PECTION REPORT REQUIRED AT PRE PLASTER. 2016 CALIFORNIA BUILDING CODEv�}f?,al'`; ,:1 FINANCIAL INFORMATION 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 SWIMMING POOL/SPA 101-0000-42404 0 $200.12 DESCRIPTION ACCOUNT CITY AMOUNT SWIMMING POOL/SPA PC 101-0000-42600 0 $108.87 Total Paid for POOL / SPA: $308.99 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 ta Qw�fra PERMIT # �� u`✓� PLAN LOCATION: Project Address:? 7� y IOW Project Description: APN #: ��ns jv)� Patio/Porch SF Email: Applicant Name: OVI rd I'u, V LA, YJ State Lic: City Bus Lic: Address: 7 %3y State Lic: City Bus Lic: City, ST, Zip: Telephone: 7AO o2 426 YP02 Email: m,q 4 /U 14 k Po*41 �e4041Valuation of Project $ 20,000 6�vj Contractor Name: New SFD Construction: Address: Conditioned Space SF City, St, Zip Garage SF Telephone: Patio/Porch SF Email: Fire Sprinklers SF State Lic: City Bus Lic: Architect/ Engineer Name: Construction Occupancy: Address: Grading: City, St, Zip Construction Type: Occupancy: Telephone: Bedrooms: Stories: # Units: Email: State Lic: City Bus Lic: Property Owner's Name: c9v 1 U &lu N New Commercial / Tenant Improvements: Address: '7A9 3y M &g4UtAZ Total Building SF City, ST, Zip �� CJ �ol� Construction Type: Occupancy: Telephone: 7AQ e Email- d << Lt 78495 CALLE TAMPICO LA QUINTA, CA 92253 760-777-7000 OFFICE USE ONLY # Submittal Required Received Plan Sets Structural Calcs Truss Calcs Title 24 Calcs j 1 CVWD Fire Flow Letter 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 Esplanade c/o Desert Resort Management, Inc. 42635 Melanie Place Palm Desert, CA 92211 Customer Care: 760-346-1161 Fax: 760-346-9918 Website: www.drinintemet.com Date: 4/10/2019 11:47:57 AM Project Ref: [43493498] 79734 Parkway Esplanade .N Daniela Cervatiuc & Ovidiu Bolon 47250 Washington St, Ste B La Quinta CA 92253 Dear Daniela Cervatiuc & Ovidiu Bolon, Thank you for submitting an Architectural Application for your improvement request. We are happy to inform you that the Esplanade Architectural Committee has approved your application for the listed project item(s), as submitted: Pool & Spa The approval is contingent upon compliance with the specifications set forth in the approved application. Esplanade acknowledges that any and all agreed changes to the original design that may be a condition of this approval will be at the homeowner's expense. The correction of any damage caused by this agreed construction will also be at the homeowner's expense. Homeowner shall henceforth agree to maintain the improvement in accordance with the guidelines and aesthetics of the community. It is the homeowner's responsibility to obtain any permits, which may be required. Please be aware this application approval does not supersede City Building Codes. You should contact the City Planning Department to determine what, if any, permits may be required. Additionally, the Board of Directors encourages that you use a licensed and insured contractor. This approval does not release the homeowner from meeting any county, state or federal requirements such as building permits, workmen's compensation, or other waivers or permits. If your project take more than 24 hours to complete, a deposit of $500.00 will be needed in order to proceed. Please bring a check addressed to the Esplanade HOA to the DRM offices, either location, and in return you will be given a sign to be placed in the front yard at your address for the duration of the project. The sign indicates to anyone passing by that your project has been approved by the HOA. Upon completion of your project, you will need to submit a signed copy of the Notice of Completion Form and return the HOA yard sign. The Committee with then inspect and sign off on your project and the deposit will processed for return. Please note there could be delays if the work was not completed as approved. We thank you for your anticipated cooperation in this process. Sincerely, Esplanade Board of Directors Esplanade c/o Desert Resort Management, Inc. 42635 Melanie Place Palm Desert, CA 92211 Main Phone: 760-346-1161 Fax: 760-346-9918 Website: www.dnnintemet.com Date: 4/8/2019 5:37:46 PM Project Ref: 79734 Parkway Esplanade .N Daniela Cervatiuc & Ovidiu Bolon 47250 Washington St, Ste B La Quinta CA 92253 Dear Daniela Cervatiuc & Ovidiu Bolon , We have received your Pool & Spa project request. It has been forwarded on to the Esplanade Architectural Committee for review. You should receive an email notification within 60 days with the approval or declined letter attached. If you have any questions regarding this matter, please contact Desert Resort Management on TownSq (online at tWs://abt).tawnNJ 0/10Pin or via the Android or iOS app). You may also email 'zeivel dtmintemet.com or mes inoza a)drmintemet.com or call 760-346-1161. Thank You, Michelle Espinoza Architectural Compliance Manager mesi2inozaa.drminternet.com Desert Resort Management, Inc. Ovidiu Bolun NAME 79734 Parkway Esplanade N ESPLANADE ADDRESS La Quinta , Ca 92253 CITY, STATE, ZIP ovidlubolun@gmall.com EMAIL ADDRESS Request details: ESPLANADE COMMUNITYA5SOCIATION C/0 Desert Resort Management P, 0, Box 14387, Palm Desert, CA 92255 Telephone: (760) 346-1161 Fax: (760 346-9918 ARCHITECTURAL REQUEST: Pg. 2 of 3 DATE 79734 Parkway Esplaande N POOL Au4�'Sy'0g. MAILING ADDRESS La Quinta , CA 92253 CITY, STATE, ZIP 760-296-8892 TELEPHONE ADJACENT NEIGHBOR APPROVAL (3y The neighbors have reviewed the plans I am submitting for Architectural Approval. I understand neighbor approval does not cause acceptance nor do objections in themselves cause denial of the application. The Architectural Committee, Board of Directors or Management may contact the neighbors to determine their objections or appropriateness if necessary. leigJhbor 1: Name Address Neighbor 1: Name JtfiCLL Neighbor 1: Name 4�i J�fC� Address ['7 u� Address FOR ARCHITECTURAL COMMITTEE USE ONLY: Date Received Comments: vale hevieweo Approved Date Disapproved Date Signature of Applicant Date ESPLANADE COMMUNITY ASSOCIATION 2of3 ARCHITECTURAL REQUEST: Pg, 3 of 3 NAME; Ovidiu Bolun SKETCH AND DRAWING PAGE Esplanade Address: 79734 Parkway Esplanade N, La Qulnta , Ca 92253 COLOR SAMPLES ATTACHED: ❑ Yes Do Explain: 3 of 3 jp,q �Ac: r0ol 5WIT HAIPJ De6ttd 5ucrloej Mlr,(Ip,i,JAJ 3' ApArr. A,Irl- tourf$ /0, Aj,-1,51,4-5r AMzovcp tl ,po ol I- pv4crJl-.' 2 -So, oca 87-0 ALL rj?ojpr4(,A'7 f"tAE.E, Jfc 33-3- i I ; PAO of Pea py(f,"t �,A3 Pfp9 PAP-KVJql 65PLANADC Qop-r" LA Q,JteITA CSA, 7,q5 voqo/6 /1,/ (olvpIrlipue-, 'o / r1l 1-11 q,vsl z v- l5 o/ MA,vJ IAajs( Loo CLGCrRICAL OAAIEI_ I is II d. h. rl Ir r !i r0ol 5WIT HAIPJ De6ttd 5ucrloej Mlr,(Ip,i,JAJ 3' ApArr. A,Irl- tourf$ /0, Aj,-1,51,4-5r AMzovcp tl ,po ol I- pv4crJl-.' 2 -So, oca 87-0 ALL rj?ojpr4(,A'7 f"tAE.E, Jfc 33-3- i I ; PAO of Pea py(f,"t �,A3 Pfp9 PAP-KVJql 65PLANADC Qop-r" LA Q,JteITA CSA, 7,q5 voqo/6 /1,/ (olvpIrlipue-, 'o / r1l 1-11 q,vsl z v- l5 o/ MA,vJ IAajs( Loo CLGCrRICAL OAAIEI_ is II rl Ir r !i ESPLANADE COMMUNITY ASSOCIATIOPI C/0 Desert Resort Management P. O. Box 14387, Palm Desert, CA 92255 Telephone: (760) 346-1161 Fax: (760 346-9918 ARCHITECTURAL REQUEST INSTRUCTIONS ARCHITECTURAL REQUEST: PgA of 3 (It is required to submit all 3 pages) INSTRUCTIONS: 1. No work shall begin until written approval from the Architecural Review Committee is obtained. 2. Fill out all Homeowner information on this page and the two forms Rev. 2 dated October 2018. 3. Be specific In your request. a. If adding a patio cover, note the type of material to be used including roofing if not a slatted roof. b, Include color sample or state color and that it is similarto the colors the home is currently painted. NOTE: Repainting your house in colors different from the current colors does not require a sketch but does require paint samples and the placrnent of colors to be submitted. c, Submit a to scale sketch or drawing of the details of the request -exactly where it Is planned, Please state on this page the dimensions and height of the components of the project. d. All buildings must conform to La Quinta building codes and a building permit is required before construction can begin. e, The following is a list of examples of projects that require written architectural approval. If you are not sure if approval is needed, submit a request or call management to discuss. i. Adding a gate, door screen, door change (home or garage) or changing your front entry into a patio area. ii. Changing your front landscape to a desert scape (from grass) or to grass (frorn desert scape). iii. Adding or removing any type of brickwork, pavers, fountains, boulders or trees. iv, Changing the front yard parking area in any way including adding cement or bricks/pavers. v, Adding play equipment vi. Sheds or other types of out buildings vii. Patio cover in front or back yard viii. Additions or modifications to homes ix, Any homeowner project (outside) that requires a permit from the City of La Quinta. 4. Before any project can be reviewed the homeowner must have 3 adjacent neighbors fill out and sign the "Adjacent Neighbor Statement" for any change/addition that is visible to a neighbor (higher than the wall), that is visible from the street, or requires a building permit from the city of La Quinta S. Any request that is not completed in full and does not have the required information will be returned to the homeowner without further review.The homeowner would be required to resubmit the request as new once all information is provided. 6. Project should begin within 30 days from receipt of approval and be completed within 120 days from the start of the project, 7. Any request that will take more than 24 hours to complete will require a deposit. 8. Before your project can begin it is required to obtain an ARC approved yard sign from the management company and provide a refundable deposit in the amount of $500.00 (check made out to Esplanade HOA) If your project will take less than 24 hours to complete, then no deposit is necessary, Failure to complete the project In the allotted time or failure to complete the project per the architectural application will result in forfeiture the deposit. 9. Project may not be started until written approval is granted and yard sign is placed in a visible location in the front yard of the home where the project is taking place, Acknowledment of all requirements' XJ +� Signature of Applicant Date o� 1of3 RECEIPT FOR ARCHITECTURAL SUBMITTAL Owner Name: Date: Association Name: Association Address / Lot Number: Items Submitted: Mgr. Notes: Blueprints / Drawings - 2 or 3 sets ]Application Color/ Material board Fees - Circle One - It is the responsibility of the owner to ensure that this submittal is complete. If it is determined any part of this architectural request is Incomplete, submittal date is void, and submittal may be returned. Until required criteria has been met (i.e. neighbor sign -off, review fees, grading plans, etc.). Dropped Off By: - Received By: w4hf 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 naive, 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: Hi hest 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 narTTC and you are personally responsible for the construction management, knowledge, workmanship, and completion of the job. You benctit 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 Si 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 99827) 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 $225,050. ■ 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. • ow a defendant in a lawsuit for reimbursement for The Owner -Builder, who has sold the home, is n benefits paid to the injured worker. Example 3: Employee of contractor without Workers Camp 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 erroneQusiy 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 Twf 4 4 Qmifirgu P.O. BOX 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT (7 60) 777-7012 pR asp ,RTY OWNER'S PACKAGE FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits IMPORTANT' NOTICE TO PROPERTY OWNER Dear Property Orty wner: ` r &// vro� An application For a building e t h s ben su #t"innur me listi g yourself t b�„der of tae prtie improvements specified at� �/ �Ilc tC� a you aware of your Weare providing you with an Owner -Builder Acknowled entet information a name s �e to teak responsibilities and possible risk you may incur by having this p of each provision, Owner -Builder. we will not issue a building permit until you have read, initis en of he owner understanding execute his notice signed, and returned this forma to us at our official addressindicated.uhn An agent unless you, the property owner, obtain the prior approval of the permitting QV�iNER'S ACKNOWLEI3GNIEN i AINiurL%1 * A understand or verify this information. DIRECTIONS: Read and initial each statement below to signify you ractice of unlicensed persons is to have the property owner obtain an "Owner -Builder” 'r 1. l understand a frequent p owner is providing his or her own labor and material personally. I, as budding permit that erroneously implies that the property not provide coverage for those an Owner -Builder, may be held liable and subject to serious financial homeowner's insurance 1emay not pr vi an unlicensed person and his or her employees while working on my property. Y 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. �� permits are not required to be signed by property owners unless they are responsible for the 2. I understand building construction and are not hiring a licensed Contractor to assume this responsibility. ect Ob -3. I understand as an "Owner -Builder" I am the edsCon ctor and having he permit fileible party of record on the d n his understand her name insteadmay oftmy myself from potcntial financial risk by hiring a licen own• 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on (0 - permits and contracts. an persons, other than California licensed Contractors, and the total value C� 5. l understand if I employ or otherwise engagey p be considered an "employ of my construction is at least five hundred dollars ($500), including labor and materials, I may under state and federal law. w, I must er with ate and federal understand if I am considered an "employer' odtn ens tiotate n disability federal a assurance, rand tcontributeetot unemployment payroll taxes, provide workers py subject me to serious financial government, withhold p yr compensation for each "employee." I also understand my failure to abide b these laws may J risk. ential 7. I understand under California Contractors' t State License Law, aforOsale, unlessrall orkbuilds ssingle-family by licensed 'structures cannot legally build them with the tont exceed four within any calendar year, or all of the work is performed subcontractors and the number of structures does under contract with a licensed general building Contractor. 0-8. I understand as an Owner -Builder if I sell the property for which thise financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the p rmut is issued, !may be held liable far any CV -9.Or materials. fJ-9. I understand I may obtain more information regarding my obligations as an "employer,, from Service, the United States Small Business Administration, 800-32I-CSLB (2752) or www.cslb_ca.gov far more the California Department of Benefit PayYnents, and the California the Internal Revenue Division of industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- meinformation about Iicensed contractors. 10. 1 am aware of and consent to an Owner -Builder building permit applied for i PAY legally and financially responsible for Proposed construction actin ty atY name,a the nd ndfollo ng at I am the address: I I. I agree that, as the party legally and f=inancially responsible for this proposed cons appticable laws and requirements that govern Owner -Builders as well as employers, tructt°n activity, I will abide by all Ohl- I2. I agree to notify the issuer of this form immediately of any additions, deletions or changes have provided on this form. Licensed contractors are regulated by laws designed to protecthe public. If youe contract inftirmatw with someone who does not have a license, the Contractors' you may sustain as a result State License Board maybe unable to assist you with any financial loss important for you to understand a complaint, Your only ftremedy against unlicensed Contractors may be in civil court. It is also d that if an unlicensed Contractor or employee Of that individual or firm is injured while working ort your property, you may be held liable for damages. If you Obtain a permit as Owner -Builder and wish to hire Contractors You will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage, Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. Signature of property owner — - — — -- -- -- Date: Note: The following Authorization Form is required to be completed by the property owner only when designatin an agent of the property owner to apply for a construction permit for the Owner -Builder. g Excluding the Notice to Property Owner the execution of which underrstON taaOPEmy p aWIYER'$ BEHALF the following persons) to act as my agent(s) to apply for, sign, Y Personal responsibility, I hereby authorize gn, 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: 1 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 �ormatton and certify its accuracy. Note. A copy of the owner's driver's license, form notarixatian, ar other verifreatian 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: r 7S -d' 4-6 ;Doul 5pli-1 H AjvJ De -Aleft 5uc-rlo(�/ N7rjq4"()+►'l 3' R P4r-T, A^rr?- t&=jEA5 /O" A51'16�A`°fj► APPNryasE por)/ L(X'j I p. - I, -, - 25o,000 7'0 NEatT€Q At,(, r(g111pP46,rt'' J"At_L fC 3EiS"�iC�a!_ J��CHor�ED I .f LM Ko uy y pl/>C 1 � . 1 i EL��rizic (oyol o I T I - =T -_g 45 it rp post MA ,VJ z-oc) A01g GLt5(,T'2tc t< PRA1L L� (3 .i «c Ca Cs 3TY OF 1A A BUILDING DIVISION REVIEWED FOR CODE COMPLIANCE LVI tie -11 5-rg E ef bPo�.kctq•mll carr 7475/ PARKWAY CYPIAmAlbF, N• 14rik L 6�� U' -V fj CITY OF LA QUINT/ _ SUB-CONTRACTORLIST JOB ADDRESS �Yq"� r cGt �ERMIT NUMBER _ OWNER � - uc�t _ _ „BUILDERThis form shall be posted on the ob wit the Building Inspection Card at all times in a conspicuous place, Only persons appearing on this list or their employee. L re 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 V�ork and/or the voidance of buildinn t)ermit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. Tradef Classification Contractor State contractor's Lice.ns.e — - ---------- ------ -Trade Workers. Compensation In.4urance. City 8us.iness. License Company Name Classification License Number Exp. Date (e.g. A, B, C-8) (xxxxxx) (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number Exp. Date License Number (Format Varies) (xx/xx/xx) (xxxx) Exp. Date (xx/xx/xx) EARTHWORK (C•12) ji?J�- CONCRETE: (.0=8) 1440/ Wc 01 eaiAA1 i FRAMING (C-5.) STRUCT. STEEL (C 51.) MASONRY .(C29) ` PLUMBING (C-3.6.) LATH. PLASTER (C.35) /J { {;� 'C✓t� �^ i�4u-� 7r3Tf7 pa,, DRYWALL (C-9) HVAC (C20) _ .ELECTRICAL (G-14.1 L I f ' C� ��U (7 �% •fid" ¢vKK¢ t.+� �� d / �I�C ROOFING(C-39) SHEET METAL (C'43) FLOORING (C"15) GLAZING (C-17) INSULATION (C-21 SEWAGE DISP. (C-42) PAINTING (C-33) CERAMIC TILE (.0-54) CABINETS (C-6) FENCING 1043) LANDSCAPING (:C=27). POOL (C-53) /% �p 2 j�dP7iG LLr�>1 �� O •L� •l c+ - / SOW*/ /Vw,— G 1191,276 �°�