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N,4AYOR <br />Miguel A. Pulido <br />MAYOR PHO TEt\,l <br />Nrichele Marlinez <br />COU NCILI,4E[,4BERS <br />P. David Benavides <br />Vicente Sarmienlo <br />Jose Solorio <br />Sal Tinajero <br />Juan Vi legas <br />CITY I'ANAGEB <br />Rau Godinez ll <br />CITY ATTORNEY <br />Sonia R. Carvalho <br />CLERK OF THE COUNCIL <br />Maria D. Huizar <br />CITY OF SANTA ANA <br />PLANNINC & BUILDINC ACENCY <br />20 Civic Center Plaza <br />P.O. Box 1988 . Santa Ana, California 92702 <br />www.santa-ana.or9/pba <br />NOTICE TO PROPERTY OWNER <br />Dear Property Owner <br />An application for a building permit has been submitted in your name listing yourself as the builder o{ the property <br />improvements specified at 'L\Lb b (ov+X N.',e S*!,.. 4"", LA 1Z+ol <br />We are providing you with an Owner-Builder Acknowledoment and lnformation Verification Form to make you aware of <br />your responsibililies 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 <br />this lorm to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property <br />owner, obtain the prior approval of the permitting authority. <br />OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON <br />DIRECTIONS: Read and initial each statement below to signity you understand or verity this information.t, \ <br />\\Jf . f understand a frequent practice ot unlicensed persons is to have the property owner obtain an "Owner-Builder" <br />o!trdfng permit that erroneously implies that the property owner is providing his or her own labor and material personally. l, <br />as an Owner-Builder, may be held liable and subject to serious financial risk lor any injuries sustained by an unlicensed <br />person and his or her employees while working on my property. My homeowner's insurance may not provide coverage lor <br />those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to <br />workers on m y property <br />2. I understand building permits are not required to be signed by property owners unless they are responsible lor <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 ol record on the permit. I understand that I may <br />ect myself f rom potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name <br />instead of my own <br />I understand Contractors are requlred by law to be licensed and bonded in California and to list their license <br />numbers on permits and contracts. <br />{- r-\ <br />2AJ-S. I understand if lemploy or otherwise engage any persons, other than California licensed Contractors, and the <br />\.ldtal value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an <br />''employer" under state and federal law. <br />6. I understand if I am considered an "employea' under state and Federal law, I must register with the state and <br />eral government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to <br />unemployment compensation of each "employee." I also understand my failure to abide by these laws may subject me to <br />serious financial risk. <br />7. I understand under California Contractors' State License Law, an Owner-Builder who builds singlejamily <br />idential structures cannot legally build them with the intent to olfer them for sale, unless a// work is performed by <br />SANTA ANA CITY COUNCIL <br />mool do@sanla.ana.oro <br />Mayo. Pro Tom, Ward 2 <br />mrmanrfl ez@santa-ana.oro <br />vicente sarmienlo <br />vsarmienlo@sanla-ana.oro isolo.io@sanla.ana.oro <br />P Davd Benavdes <br />dbemvides@sanla-ana.oro iv lleoas@santa ana.oro sllnaiero@sanla-ana.oro <br />10)tao9 / <br />ti