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APP.r3 CBC 2016 Dear Property Owner: An applicati specified at on for a uild n e It S een sub ed NOTICE TO PROPERTY OWNER name lis youv elf a builder of the property improvements We are providing you with an Owner-Builder Acknowledoment and information Verificalion Form to make you aware of your respo n sib ilitre s and possible risk you may incur by having this permlt 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 ACKNOWLEG IVENT AND VERIFICATION OF INFORMATON DIRECTIONS: Road and lnitial each statement below to signify you understand ot ve fy this lnformation. .,t l$_L/ 1. I undersland a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Euilde/' build- ing permit that enoneously implies that the property owner is providing hrs 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 propeny. My homeowneds insurance may not provide coverage for those injuries. I am wllfully acting as an Owner€uilder and am aware of the limrts of my insurance coverage for injuries to workers on my proF erty 2. I understand building permits are not required lo be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. \M-S f understand as an 'Owner-Builded I am the responsible party oF record on the permiL I understand that I may protect 'myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. I Vo , understand Contractors are required by law to be licensed and bonded in California and to list their license numbers bn permits and contracts. \M_S. t understand if I employ or otheMise engage any persons other than California licensed Contractors, and the total lrilue of my construction is at least flve hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. lV U tunderstand if I am considered an 'employer' under state and Federal law, I must register with the state and tederal !6iEhment, withhold payroll taxes, provide workeri' compensation disability jnsurance, and c6ntribute to unemployment com- p€nsation of each "employee," I also understand my failure to abide by these laws may subject me to serious financial risk. .\r., \]Z-r. , understand under California Contractors' State License Law, an Owner-Builder who builds single-lamily residential ltructures cannot legally build them with the intent to offer them for sale, unless a// work is performed by licensed subcontrac- :ors and the number of structures does not exceed four within any calendar years, or all of the work is performed under contract ,vith a licensed general building Contractor. \L/ 8. I understand as an Owner-Builder if I sell the property for whlch this permit is issued, I may b€ held liable for any finan- :ibl or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman- ihip or materials. Plan ning & Building Agency Bullding Safety Division 20 Civic Center Plaza P,O. 8ox 1988 (Ml9) Santa Ana, CA 92702 (714) 647-5800 www.sa nta.ana.org