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Plann ing & Building Agency Building Safety Division 20 Civic C enter Plaza P.O. Box 1988 (M-1 9) Santa Ana, CA 92702 (714) 647-s800 www.santa-ana.org APP-13 CBC 2016 NOTICE TO PROPERW 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 D We are providing you wjth an Owner-Builder Acknowledoment and lnformation Veriflcation Form to make you a',vare of your re spon srbilitle s and possible risk you may incur by having this permit issued in your names 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 offlcial address indicated. An agent of the owner cannot exscute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWN E R'S ACKNOWLEGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand or verify this infomation. Z't I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Buildef' buald- ingFpermrt that erroneously implies that the propedy owner is providing his or her own labor and material personally. l, as an OwnerBuilder, may be held liable and subject to serious flnancial 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 iniuries to workers on my prop- erty. ,,// --Z!!_Z I understand burlding 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. 4Z I understand as an "Owner-Builde,'' I am the responsible party of record on the permit. I understand that I may protect myself from potential flnancial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. ^,/t'/ 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permrts and contracts. 4-S I understand jf I employ or otheMise engage any persons, other than California licensed Contractors, and the total valde of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employe/' under state and federal law. ^y'/ U. 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 com- pensation of each "employee." I also understand my failure to abide by these laws may subiect me to serious financial risk. 7. I 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 a// work is performed by licensed subcontrac- :ors and the number of structures does not exceed four wathin any calendar years, or all of the work is performed under contract l/ith a licensed general building Contractor. n 4, ,understand as an Owner-Builder if I sell the property for which thrs permit is issued, I may be held liable for any finan- :ial 5r personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman- ;hip or materials. o