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MAYOR Miguel A. Pulido MAYOR PRO TEM Claudia C. Alvarez COUNCILMEMBERS P. David Benavides Carlos Bustamante Michele Martinez Vincent F. Sarmiento Sal Tinajero CITY MANAGER . David N. Ream CITY ATTORNFY Joseph w. rlrrer L CLERK OF THTOUNCIL Maria D. HuiAr CITY OF SANTA ANA PLANNING & BUILDING ACENCY 20 Civic Center Plaza P.O. Box I988. SantaAna, California92TOz www.santa-ana. org 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 B 0t - /|uN ff fa,ur,q 4u, c4 1t-t n t We are providing you with an Owner-Builder Acknowledqment and lnformation Verification Form to make you aware of your responsibilities 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 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 ACKNOWLEGMENT AND VERIFICATION OF INFORMATON 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" 6[itOing permit that erroneously implies that the property owner is providing his or her own labor and material personally. l, 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. LN 2 I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not niring a licensed Contractor to assume this responsibility.-./a./-[ V 3. 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 Contract,or and having the permit filed in his or her name inst6ad of mv own.(./-lV-O I understand Contractors are required by law to be licensed and bonded in California and to list their license nyarUers on permits and contracts. (nf \V 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the totalvalue of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an under state and federal law 6. I understand if I am considered an "employer" under state and Federal law, I must register with the state and federal goyernment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemplo/ment compensation of each "employee " I also understand my failure to abide by these laws may subject me to seriouslinancial risk \/, I understand under California Contractors' State License Law, an Owner-Builder who builds single-family reJE-entiat structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor.