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MAYOR Miguel A. Pulido MAYOR PRO T EM V incen t F. Sarmiento COUNC IL MEMBER S Angeli ca Amezcu a P. David Benavides Micilele Martinez Roman Reyna Sal Tinajero Dear Prope rty Owner: CITY OF SANTA ANA PLANN ING & BUILDI NG AGENC Y 20 Civic Center Pl a z a P.O. Box 1988 • Santa An a, California 92702 w ww.sa nta-ana.org /p ba NOTIC E TO PROPERTY OWN ER C ITY MANAGER David Cavazos CI T Y ATTORNEY Sonia R. Carvalilo CLERK OF THE COUNCIL Maria D. Hui zar An application for a bu ilding per mit has been submitted in your name lis ting yours e lf as the builder of the property improvements specifie d at (1 {£ it( C-t\J br Lif,v ~ 9b"iD4 ~A: qlrJ of, I We are provid in g you w ith an Owner-Builde r Ackn owl edgment and Informat ion V er ification Form to make you aware of your respo nsibilities a nd possible risk you may incur by having this permit iss ued in your names as the Owne r-Bu ilder. We wi ll not issue a building perm it un til yo u have read, initialed you r understa nd ing of each provision, s igned , and returned t his form to us at ou r official address ind icated. An ag en t of the owner cannot execute this notice unless you, the property owner , obta in the prior approval of the p ermitting autho ri ty. OWNER'S ACKNOWLEDGMEN T AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. rt_ 1. I understand a frequent practice of unlicensed persons is to have the p roperty owner obtain an "Owner-Bu ilder" building permit that erroneous ly implies that the property owner i s provid ing his or her own labor and material persona lly. I, as an Owner-Builder, may be held liable and subj ect to ser ious financial risk for any injuries sustained by an unl icensed person and his or her employees while workin g on my property. My homeowner's insura nce may not provide coverage for those injuries. I am willfully acti ng as an Owner-Builder and am aware of the lim its of my insurance coverage for injuries to wor ke rs on my property. ~2. I understand building pe r mits are not required to be signed by property owners unless they are respons ible for t he construction and are not hi r ing a licensed Contractor to assume this respo nsibility. ,-J 3. I understand as an "Owner-Builder" I am the responsible party of record on the perm it. I understand t hat I may protect myself from po te ntial financial risk by hiring a licensed Cont racto r and having the perm it filed in his or he r name instead of my own. ~ 4. I understand C o ntractors are requ ired by law to be licensed and bonded in Californi a and to list their li cens e numbers on perm its and co ntracts . ·,J 5. I understand if I employ or o therwise engage any persons , other than California licensed Contractors, and th e total value of my c onstruction is at least fi ve hundred dollars ($500), includ ing labor and materials , I may be cons idered an "employer" u nd er state and federa l law. -'( J 6 . I understand if I am c onsidered an "employer" under state and Fede ral law, I must reg is ter with the state an d federal government, withhold payrol l taxes , provide worke rs' compe nsation disability insurance, and contribute to unemployment compensation of each "employee." I a lso understand my fa il ure to a b ide by these laws may subj ect m e to s~)ious financia l ris k . ~ __ 7. I understa nd under California Contractors ' State License Law, an Owner-Builder who builds single-family re sident ial str uctures ca n not legally build them with the in tent to offer them for sa le , unless a ll work is performed by licensed subcontractors and the nu mber of structures does not exceed four w ithin any ca len dar years , or a ll of the work is perform ed und e r contract w ith a lice nsed general buildi ng C on tractor . Miguel A Pulido Mayo, MPuhdo(@santa•ana.org SANTA ANA CITY COU NCIL Vmcent F. Sarmiento Michele Martinez Mayor Pro Tem, Ward 1 Ward 2 VSarm1en1o@san1a-ana .org MMart1ne z@san1a-ana.org Angelica Amezcua Ward 3 P. David Benavides Ward 4 AAmezcua@santa-ana .org DBenav1des@santa•ana.org Roman Reyna Ward 5 RReyna@santa-ana .org Sal T1na1ero Ward 6 ST1na1er9@santa-ana.org