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MAYOR MiguelA. Pulido MAYOR PRO TEM SalTinajero COUNCILMEIMBERS Angelica Amezcua P. David Benavides Michele Martinez Roman Reyna Vincenl F Sarmrenlo CITY OF SANTA ANA PLANNINC & BUILDING ACENCY 20 Crv ( Center Plaza P.O. Box 1988 . Santa Ana, Calafornia 92702 www.Santa ana.orglpba NOTICE TO PROPERTY OWNER Dear Property Owner An application for a buildi it has been subm tted in your name lis rself as the buil of the prope(yg you improvements specified at We are providing you with an Owner-Builder Acknowledqment 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 ACKNOWLEGMENT AND VERIFICATION OF INF ORMATON DIRECTIONS: Read and initial each statement below to signify you understand or verify this information- 'Z-a!t I I understand 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. lrly homeowner's insurance may not provide coverage for those iniuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. =-fAZ I understand building permits are not required to be signed by property owners unless they are responsible for me construction and are not hiring a licensed Contractor to assume this responsibility. .Zl]S. I understand as an "Owner-Buildea' I am the responsible party of record on the permit. I understand that I may orotect myself from potential frnancial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. I ZYq. I understand Contractors are required by law to be licensed and bonded in California and to list their license r1!mbers on permrts and contracts..t -ZA, I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the lotal'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. -1-I1A. I understand if I am considered an "employer" under state and Federal law, I must register with the state and tederal government. withhold payroll taxes, provide workers'compensation disability insurance, and contribute to unemployment compensation of each "employee." l also understand my failure to abide by these laws may subject me to serious financial risk. l.-Bl 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 performed 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 licensed general building Contractor. CITY I\,IANAGER David Cavazos CITY ATTORNEY I Sonia R. Ca.valho CLERK OF THE COUNCIL Maria D. Huizar I