DRVA2017-0001See below for Finance Revenue Codes
ENCROACHMENT PERMIT
OF
PUBLIC WORKS CONSTRUCTION
For the construction of public or private curbs, driveways, pavements, sidewalks, parking lots, se
works improvements in connection with MINOR IMPROVEMENTS and APPROVED SUBDIVISIONS.
DATE: 1/9/2017
LOCATION OF CONSTRUCTION(Street address or Description): 53860 AVENIDA HERRERA
PURPOSE OF CONSTRUCTION: DRIVEWAY APPROACH
DESCRIPTION OF CONSTRUCTION: DRIVEWAY APPROACH: MAROHN
DIMENSION OF INSTALLATION OR REMOVAL: DRIVEWAY APPROACH
m)th4iJke
201
CITY OF LA QUINTA
DESIGN AND DEVELOPMENT DEPARTMENT
IMATE TIME WHEN WORK WILL BEGIN: 1/12/2017 TIMEOF COMPLETION: 1/26/2017
ESTIMATED CONSTRUCTION COST: $200.00 (Including removal of all obstruction, materials, and debris, backfilling, compaction and
placing permanent resurfacing and/or replacing improvements)
COMMENTS:
In consideration of the granting of this permit, the applicant hereby agrees to:•
Indemnify, defend and save the City, its authorized agents, officers, representatives and employees, harmless from and against any and all
penalties, liabilities or loss resulting from claims or court action and arising out of any accident, loss or damage to persons or property
happening, or occurring as a proximate result of any work undertaken under the permit granted pursuant to this application.
Notify the Administrative Authority at least twenty-four (24) hours in advance of the time when work will be started at (760) 777-7097. To
submit an inspection request, leave a message on the Inspection Request Hotline at (760).777-7097 prior to 1:30 P.M. at least twenty-four
(24) hours. prior to the anticipated inspection.
Comply with all applicable City Ordinances, the terms and conditions of the permit and all applicable rules and regulations of the City of and
to pay for any additional replacement necessary as the result of this work.
of Applicant or Agent
JAMES MAROHN 53860AVENIDAHERRERA LA QUINTA, CA 92253
.
(760)609-8528
Name of Applicant (please print) Business Address Telephone No.
OWNER/BUILDER ,
Name of Contractor and Job Foreman Business Address . Telephone No.
Contractor's License No. City Business License No.
Applicant's Insurance Company
-
Finance Revenue Code
Credit Card Fee $2.74
PERMIT INSPECTION
DRIVEWAY RESIDENTIAL . $152.00
TOTAL: $154.74
Policy Number
PERMIT NO: DRVA2017-0001
DATE ISSIiED:I,Li/17
EXPIRATION DATES /
WORK INSPECTED BY*:
PERMIT COMPLETION DATES:
If the work is covered by a Subdivision Improvement Agreement,
Subdivider shall request final acceptance of improvements from the
City Council.
DRIVEWAY APPROACH PERMIT APPLICATION
finance Revenue Code P0
Applicant Information:
Applicant/Owner (please pjt name here): 1~_rvo_=-
Applicant Address: 63& IflVck \ejrc LQo'-q CO
Number Street City State Zip Code
Address or Parcel No. of work location, if different from applicant's address above: .
Number . Street . City . State Zip Code
Date: I I 1/JT 7 Applicant's Phone No: (70) (oq - a
Applicant's Signature:
-
Approximate Start Date: ......L/9/17 Approximate Completion Date:
Contractor Information:
Address: IJj'J
Number
Phone Number: _____
City Business License Number:
General Liability Insurance Con
City State Zip Code I
Contractors License Number:
Policy No.
Request for Inspection - Please call (760) 777-7097 before 1:30pm to request an inspection at least 24
hours prior to your requested inspection date. Public Works Counter (760) 777-7075.
Please Note: Inspections are normally performed Monday through Friday between 8am and 4pm
Permit Fee $445 = $445 Total Fee I 32
Permit No. Expiration Date II
Permit Issued by: Date Issued
Signature of Administrative Authority
Work Inspected by: Permit Completion Date:
Inspector's Signature
Comments:
Note: Driveway approach must be constructed per Cityof La Quinta Standard #221
c 4:4Qg14L.
BUILDING & SAFETY DEPARTMENT
78-49 5 CALLE TAMPICO • (760)777-7012
LA QUINTA, CALIFORNIA 92253 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!
Wring 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.
S
Benefit/Risk: Hiahest Benefits and the Least amount of Risk
Owner-asWorker 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 ofthejob. You
benefit by not paying others to perform this work for you and your risk depends on your own ability to complete the job successfully.
Benefit/Risk: Possible Benefit with Low Financial Risk
Owner-as-Contractor is a type of Owner-Builder where you personally act as your own General Contractor, the permit is taken out in-your name and you hire California licensed sub-contractors to perform portions of the construction work. WARNING: The benefit of
protection provided by law when you hire only California. licensed sub-contractors can turn to serious financial risk if you hire
unlicensed contractors to perform any of the work.
Benefit/Risk: Possible Benefit and Significant Financial Risk
Owner-as-Employer is a type of.Owner-Builder where you pay any unlicensed individual to perform any construction work valued at more than $500.00, the permit is taken .out in your name and you are- personally responsible for their employment requirements,
supervision, performance, safety and welfare while on your property. WARNING: Cost savings benefit can turnto serious financial
risk if you fail to deduct payroll taxes or provide workers compensation insurance for each worker. S
BenefitIR.isk 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 a 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-inlaw 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 Buld r" 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 'emloyer. 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
Tdf.4 449 a
P.O. Box 1504
LA QIJINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPIcO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
(760) 777-7012
FAX (760)777-7011
PROPERTY OWNER'S PACKAGE
Disclosures & Forms for Owner-Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER S
Dear Property Owner:
An application for a buildin permit has been submitted in your name listing yourself as the builder of the property
improvements specified at 596W f44*2n b4 HeTerc!l.
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 venfy this information.
kt9l. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder"'
uilding jermit 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.
ii? 2.. I understand building permits are not required to be signed by property owners unless they are responsible for the onstruction and are not hiring a licensed Contractor to assume this responsibility.
Dl 3. 1 understand as an "Owner-Builder" I am the responsible party of record on the permit I understand that Imay protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or he name instead of my own.
S
4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts.
177 5. I understand if! 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.
I understand if! 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.
.
tbc
I understand under California Cotractors' State License Law, an Owner-Builder who builds single-family residential tures cannotlegally build them with the intent to offer them for sale, unless all work is' performed by licensed ontractors 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.
1- I
I understand as an Owner-Builder if I sell the property for which this permit is issued; I may be held liable for any inancial or per injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials.
I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United Stites 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.
I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the
Pi
legally. and financially responsible for proposed construction activity at the following address:
(OO eyeniDej 6/1'cr€r' zq gozviti C4 t5
1 agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all plicable laws and requirements that govern Owner-Builders as well as employers.
~2
12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
-veprovided 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 bein civil court. It is alo 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 is required to be presented when the permit is issued to verify the property owner's signature.
Signature of property owner Date: 1 II i
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to applyfor a construction permit for the Owner-Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
. Tel No
Address of Authorized Agent:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature.
Property Owner's Signatures . Date: