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T/AYOR Miguel A. Pulido MAYOR PRO TEM lVichele Martinez COUNCILMEI\,IBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinaiero Juan Villegas CITY OF SANTA ANA PLANNINC & BUILDINC AGENCY 20 Civic Center Plaza P.O. Box 1988 . Santa Ana, California 92702 www.santa-ana.org/pba 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 improvementsspecified" Dathi cev\ke-rr 5ioq €- c€]^4'ml Aw, sart"{a Av.a UQtnol We are providing you with an Owner-Builder Acknowledoment 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 ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. L.,t ( 1 I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" buihing 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 unl'censed person and his or her employees while working on my property. l\4y 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. L+( 2 | understand building permits are not required to be signed by property owners unless they are responsible for thb bonstruction and are not hiring a licensed Contractor to assume this responsibility. \-N,_4. I understand Contractors are required by law to be licensed and bonded in California and to list their license nultrbers on permits and contracts. VI'( 5. lunderstand if I em ploy or otherwise engage any persons, otherthan California licensed Contractors, andthe tot5l value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. 1v/}{ 0. t understand if I am considered an "employer" under state and Federal law, I must register with the state and fe&ral government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation of each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. W I I understand under California Contractors' State License Law, an Owner-Builder who builds single-family re$idential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by SANTA ANA C TY COUNC L ACTING CITY MANAGER Gerardo Mouet CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar mou do6sanla-a.a oro Mayor Pro Tem Ward 2 mrmarlinez@sanla-a.a oro Vrcente Samenro vsa16renlo@sa.l3-ana oro solono@sa.la-ana oro P David Benavdes dbe.avdes@santa-ana o.o v eoas@saita-ana oro s1 narero@sa.la-ana c,o Uh( 3 I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may prlltect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own.