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MAYOR Miguel A- Pulido MAYOR PRO TEM Michele Martinez COUNCILMEI.4BERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas Dear Property Owner An application for a building improvements specified at ACTING CITY MANAGER Gerardo Mouet CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar CITY OF SANTA ANA PLANNINC & BUILDINC AGENCY 20 Civic Center Plaza P.o. Box I 988 . Santa Ana. Califo.nia 92702 www.santa- ana.org / pba NOTICE TO PROPERTY OWNER has been submitted in your name listing yourself as the builder of the propertypermit 3ol Sot -(4ur\n-U.,l-cft Lza 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 XTRECI/OilS; Read and initial each statement below to signify you understand or verify this information. IW ,. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" 6'dilding 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 m y property 2. I understand building permits are not required to be signed by property owners unless they are responsible for nstruction and are not hiring a licensed Contractor to assume this responsibility. 3. 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 eco 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. iN-U n understand if I am considered an "employer" under state and Federal law, I must register with the state and'federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemploymentcompensationofeach'employee.'lalsounderstandmyfailuretoabidebytheselawsmaysubjectmeto serious financial risk. Uv\411understand under California Contractors' State License Law, an Owner-Builder who builds single-family res{dential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by SANTA ANA CITY COUNCIL moulido@sanla-ana.oro Mayor Pro Tem Ward 2 mifr 6rtinez@sanla ana.oro isorono@sanla-ana,oro P. Oavrd 8€navides dbenavides@santa-ana.o.o rvilleoasrAsanla ana oro sl .aiero@sanla-ana oro instead of rly own. Wif ,nO"rstand Contractors are required by law to be licensed and bonded in California and to list their license humbers on permits and contracts. hld ' understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the Vicente Sa.mlenlo vsarmienro@santa-ana or0