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Planning & Building Agency <br />Building Safety Division <br />20 Civic center Plaza <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647-5800 <br />wl w.santa-ana.org <br />APP.13 CBC 20,16 <br />NOTICE TO PROPERTY OWNER <br />Dear Property Owner: <br />An application for b ld in p it has n submitted in ur name listin s rsel the bu ilder the mp rovements <br />We are providing you with an Owner-Builder Acknowledqment and lnformation Verification Form to make you aware of your <br />responsibilities and possible risk you may incur by having this permit issued in your names as the Owner-Builder <br />We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this <br />form to us at our offlcial address indicated. An agent of the owner cannot execute this notice unless you, the property owner, <br />obtain the prior approval of the permitting authority. <br />DIR O/VS j Read and initial each statement below to signify you understand or verify this information. <br />I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" build- <br />ing permit that erroneously implies that the property owner is providing his or her own labor and material personally. l, as an <br />Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and <br />his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I <br />am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my prop- <br />erty. <br />2. I understand buildin g permits are not required to be signed by property owners unless they are responsible for the <br />construction and are not hiring a licensed Contractor to assume this responsibility <br />3. I understand as an "Owner-Builder'' I am the responsible party of record on the permit. I understand that I may protect <br />myself from potential financial risk by hiring a licensed Contractor and having the permit flled in his or her name instead of my <br />own. <br />4. I understand Contractors are re quired by law to be licensed and bonded in California and to list their license numbers <br />on rmits and contracts <br />I understand if I employ or otherwise engage any persons, other lhan California licensed Contractors, and the total <br />value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an <br />"em oyer, under state and federal law <br />6. Iunderstand if Iam considered an "employer" understate and Federal law, I must register with the state and federa l <br />governme nt, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment com- <br />tion of each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk <br />7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential <br />structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by licensed subcontrac- <br />tors and the number of structures does not exceed four within any calendar years, or all of the work is performed under contract <br />a licensed general building Contractor <br />8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any finan- <br />bial or personal injuries sustained by any subsequent owne(s) that resu <br />ship or materials <br />It from any latent construction defects in the workman- <br />specified at <br />OWNER'S ACKNOWLEGMENT AND VERIFICATION OF INFORMATON