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MAYOR Miguel A. Pulido MAYOR PRO TEM Vicente Sarmiento COUNCILMEMBERS Angelica Amezcua P. David Benavides Michele Martinez Roman Reyna Sal Tinajero Dear Property Owner: An applicatio improvements spe,,..,·,T,·,=:,-"• CITY OF SANTA ANA PLANNING & BUILDING AGENCY 20 Civi c Center Plaza P.O. Box 1988 • Santa Ana, Ca liforni a 92702 www.santa-ana.org /pba NOTICE TO PROPERTY OWNER CITY MANAGER David Ca v9zos CITY ATTORNEY Son ia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar 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. v:1L. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" ~§I 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 injuries to workers on my property. \ ~-I understand building permits are not required to be s igned by property owners unless they are responsible for ~~struction and are not hiring a licensed Contractor to assume this responsibility. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name of my own. ~ I understand Contractors are required by law to be licensed and bonded in California and to list their license ~~iers on permits and contracts . ...>...Ll.-'--r-· I understand if I employ or otherwise engage any persons, other than California licensed Contractors , and t he I alue of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an ployer" under state and federal law. -=..,_....__~-· I understand if I am considered an "employer" under state and Federal law, I must register with the state and r I government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to u mployment compensation of each "employee." I also understand my failu re to abide by these laws may subject me to serious financial risk . 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family ntial structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by nsed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is performed under contract wi th a licensed general building Contractor. • Miguel A. Pulido Mayor MPulido@santa-ana.org SANTA ANA CITY COUNCIL Vicente Sarmiento Michele Martin ez Angelica Amezcua P. David Benavides Mayor Pro Tern, Ward 1 Ward 2 Ward 3 Ward 4 VSam,iento@santa-ana.org MMartinez@santa-ana.org AAmezcua@sa nta-ana org DBenavides@santa-ana .erg Roman Reyna Ward 5 RReyna@santa-ana.org Sal Tinajero Ward6 STinajero@santa-ana.org