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MAYOR Miguel A. Pulido MAYOR PRO TEM Sal Iinajero COUNCILMEMBERS Angelica Amezcua P. David Benavides Michele Martinez Roman Reyna Vincent F. Sarmiento CITY MANAGER Davad Cavazos CITY ATTORNEY Sonia R. Carvajho CLERK OF THE COUNCIL Maria D. Huizar Dear property owner: NorlcE To PRoPERTY owNER An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specmed " 115 6. nU+o., Altâ‚¬rrr{, \nnU rR^^, CA go)o? We are providing you wilh an Owner-Builder Acknowledqment and lnformation Verification Form to make )lou 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 pâ‚¬rmit 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 ACKNOWLEGMENT AND VERIFICATION OF INFORMAT ON DIRECTIONS: Read and initial each statement below to signify you understand or veify this information- V't . tunderstand a frequent practice of unlicensed persons is to have the property owner obtain an 'Owner-Builder" building 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 nol 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 wotRyron my property. V z. I understand building permits are not required to be signed by property owners unless they are responsible for the con ction and are not hiring a Iicensed 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 protect myself from potential financial risk by hiring a licensed Contractor and having the permit flled in his or her name instea9f my own. -V o , understand Contractors are required by law to be licensed and bonded in California and to lisl their license numbers on permits and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construclion is at least five hundred dollars ($500), including labor and materials, I may be considered an "empl r'under state and federal law fed.ra 6. I understand if I am considered an "employer' under state and Federal law, I must register with the state and I government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unem oyment compensation of each 'emoloyee." I also understand my failure to abide by these laws may sub.iect me to flnancial risk.ser S 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless a// work is pe*ormed by licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is performed under contract with a licenseC general building Contractor. CITY OF SANTA ANA PLANNING & BUILDING ACENCY 20 Civic Center Plaza P.O. Box I988. Santa Ana, California 92702 www,santa-ana.o19/pba