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MAYOR Miguel A. Pulido MAYOR PRO TEM Vicente Sarmiento COUNCILME MBERS Angelica Amezcua P. David Benavides Michele Martinez Roman Reyna Sal Tinaj ero Dear Property Owner: CITY OF SANTA ANA PLANNING & BUILDING AGENCY 20 Civic Center Plaza P.O. Box 1988 • Santa Ana, Cal ifornia 92702 www.santa-ana.org / pba NOTICE TO PROPERTY OWNER CI T Y MANAGER David Cavazos CI T Y ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at 17 I > Y'1 c.. Evoy L A-rJ~ , 5 /f:N'D:1-MA-C/----v 7 D (:, I I 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 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 ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand or verify this information . -:r}_ 1 _ I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" building permit 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 inju ries to workers on my property. TV 2 . I understand building permits are not required to be signed by property owners unless they are respons ible for the construction and are not hiring a licensed Contractor to assume this responsibility. ---3J/._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 Contractor and having the perm it filed in his or her name instead of my own . ~ 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. ,V 5. I understand if I employ or otherwise engage any persons, other than California li censed 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. \ J 6. I understand if I am considered an "em ployer" under state and Fede ral law, I must register with the state and federal government, withhold payroll taxes , provide workers' compensation disability insurance, and contribute to unemployment compensation of each "employee." I also understand my fa ilure to abide by t hese laws may subject me to serious financial risk. ~ 7. I understand under California Contractors' State Licen se Law, an Owner-Builder who builds singl e-family residential 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 structu res does not exceed four within any ca lendar years, or all of the work is performed under contract with a licensed general building Contractor. M[guel A. Pulido Mayor MPulido@santa-ana .org SANTA ANA CITY COUNCIL Vicente Sarmiento Michele Martinez Mayor Pro T em, Ward 1 Ward 2 VSarmiento@san ta-ana .erg MMartinez@santa-ana .erg Angelica Amezcua Ward 3 P. David Benavides Ward4 Mmezcua@santa-ana.org DBenavides@santa-ana .prg Roman Reyna Wards RReyna@santa-ana.org Sal Tinajero Ward 6 STinajero@santa-ana.org