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MAYOR N4iguel A. Pulido I\4AYOR PRO TEiT l\4ichele Martinez COUNCILMEI\,4BERS P. David Benavides Vicente Sarmiento Jose Solo.io SalTinajero Juan Villegas CITY OF SANTA ANA PLANNINC & BUILDINC ACENCY 20 Civic Center Plaza P.O. Box 1988 . Santa Ana, California 92702 www.santa-ana.org/pba NOTICE TO PROPERW OWNER Dear Property Owner An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at q (+.?5 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 ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON DSSI/OIJS: Read and initial each statement below to signify you understand or verify this information. X1 . f 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. My homeowner's insurance may not provide coverage for those injuries. I am wjllfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to ryorkprs on my property. cot4l. Y, Z I understand building permits are not required to be signed by property owners unless they are responsible for thAaorstruction and are not hiring a licensed Contractor to assume this responsibility.()E) 2{ , understand as an "Owner-Buildel' 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 Coniract,cr and having the permit filed in his or her name instead of mv own.(x) )4 + t understand Contractors are required by law to be licensed and bonded in California and to list their license ?r\mlers on permits and contracts.\.b)X, s. t understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "enolqyer" under state and federal law.GJbt 5O , understand if I am considered an .employer" under state and Federal law, I must register with the state and federal gouernment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation of each "employee." I also understand my failure to abide by these laws may subject me to seridus financial riskI/\ 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 performed by SANTA ANA CITY COUNCIL ACTING CITY I\,IANAGER Gerardo Mouet CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL l\ra a D. Huizar moul do(osanla-ana oro Mayor Pro Tem, Ward 2 mim6dinez@sania'ana.o.o vsa rn e.lo,Osanta-anE oro so ono@sanla anz.oro P Dav d Benavdes dbenavdes@santa-ana ora ivl soas@sanb-ana.oro slinaie.o@santa-ana.oro