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MAYOR <br />N/iguelA. Pulido <br />MAYOB PRO TEI\.4 <br />Michele l\rartinez <br />COUNCILI\,4EN,llBERS <br />P. David Benavides <br />Vicente Sarmiento <br />Jose Solorio <br />SalTinalero <br />Juan Villegas CITY OF SANTA ANA <br />PLANNINC & BUILDING ACENCY <br />20 Civic Center Plaza <br />P.O. Box 1988 . Sanra Ana. California 92702 <br />www.Santa-ana.org/ pba <br />NOTICE TO PROPERTY OWNER <br />Dear Property Owner <br />An application for a building permit has been submitted in your name listing yoursell as the builder of the property <br />improvements specified ut rgce ut> .Ctrenurcrj D i 6Gn\c. Arva t A Cz-.zo\ <br />OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON <br />DIRECTIONS: Read and initial each statement below to signity you understand or verity this intormation. <br />1l \r . r understand a f requent practice of unlicensed persons is to have the property owner obtain an "Owner-Buildei' <br />bui[ding permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, <br />as an Owner-Builder, may be held liable and subject to serious financial risk for 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 for <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 my property. <br />, 1J). I understand building permirs are not required to be signed by property owners unless they are responsible for <br />the construction and are not hiring a Iicensed Contractor to assume this responsibility. <br />, / /-1.r. I understand as an 'Owner-Buildei' I am the responsible party of record on the permit. I understand that I may/ frot6ct myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name <br />instead ol my own. <br />,, / i>+ I understand Contractors are required by law to be licensed and bonded in California and to list their license <br />nuffbers on permits and contracts. <br />5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the <br />tot 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 />lJj. I understand if I am considered an "employer" under state and Federal law, I must register with the state and' led6ral government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to <br />unemployment compensation ol each "employee." I also understand my lailure to abide by these laws may subject me to <br />serious financial risk. <br />/{t L t )7. I understand under Calilornia Contractors' State License Law, an Owner-Builder who builds singleJamily <br />residential structures cannot legally build them with the inlent to offer them for sale, unless a//work is performed by <br />SANTA ANA CITY COUNCIL <br />CIry MANAGER <br />Raul Godinez ll <br />CIry ATTORNEY <br />Sonia R. Carvalho <br />CLERK OF THE COUNCIL <br />l\,4aria D. Huizar <br />moulldords6.ta-ana oro <br />Mayor P.o Teh, Ward 2 <br />m han nez@sanla ana oro <br />Vl.ente Sarmicnr. <br />vsarmlenlo@santa a.a.oro <br />We are providing you with an Owner-Builder Acknowledoment and lnformation Verification Form to make you aware of <br />your 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 <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 lhe permitting authorily- <br />isolorio@sanra-ana.oro <br />P oavd Benavides <br />dbenaedes@sanIa-ana.oro iv eoas@sanla'ana oro slinaiero@sanla.ana.oro