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t Plannino & Building Agency <br />Building Safety Division <br />20 Civic Center Plaza <br />P.O. Borl96E (M-19) <br />Sania Ana, CA 92702 <br />(7r4) 647-5E00 <br />www.santa-ana,org <br />f*4re5'f ' <br />@f-r.rt{ (oe <br />tor\oto2\ <br />APP-I3 CBC 20.t6 <br />NOTICE TO PROPERTY OWNER <br />Dear Properly Owner: <br />An applicat ion for a buildi ng has nsu itted i your na yo as the bui of property im provements <br />specified at <br />We are pmriding you with an Owner-Buildgr Acl(nqwledoment and lnformation Verification Form to make you aware of your <br />responsibilities and possible risk you may incur by having lhis permit issued in your names as ttre Ownor-6uider. <br />we will not issuo a hlilding permit until you have read, initialed your understanding of each proMsion, sllned, and retumed this <br />form to us al our official address indicated. An agent of the owner cannot execute this notice unlass you, the property owner, <br />oblain the prior approval ofthe permitting authority. <br />OWNER'S ACKNOWLEGMENT VERIFICATION OF INFORMATON <br />DrFEcrrolrs: React and iniflal each stalc.ment lr.torr to stgn/fy you undersland d veity this tntor,rnaaon. <br />--?.)(J2Ll I understand a frequent practice of unlicensed persons is to have the properry o\yner obtain an.Owner-Buihoa build- <br />ing permit that enoneously implies that the property owner is providing his or her own labor and material personally. l, as an <br />Olvner-BuiHer, may be held liable and subjecl to serious financial rbk for any injuries sustained by an uniicensed ierson andhb or h€r employees while working on my property. My homeowneis insurance may not provide covBrage for those injuries. I <br />am willfully actinq as an OwnerSuilder and am aware of the limits of my insurance co\rerage for iniuries to workers on my prop <br />erty. <br />-?/?(r'42. I underslaM building permits are nol requirod to be signed by property owners unless they are responsible brth6 <br />construclion and are not hiring a licensed Contractor to assume lhis responslbility. <br />-?ztCJ4?: I understand as an 'Owner-Buildef lam the responsible party of recod on the permit. I understand that I may protect <br />mysetf trom potential nnancial risk by hiring a licensed Conlractor and having the permit filed in his or her name instead of my <br />own. <br />&, I undorstand contractors are r€quirBd by law to be licensed and bonded in catifomia ond to list their tic€nse numbers <br />on pemits and comracts. <br />--O2CL W I understand if I employ or otheMise engage any persons, other than Califomia licensod Cor[ractors, and the totat <br />value 6f my conslruclion is al leasl five hundred dollars ($500), including labor and materials, I may be considered an'employef under stale and federal law. <br />--?a7{$A. t understand if lam consireted an "employer" under stale and Federallaw, lmust register with the state and federal <br />govemment, withhokt parolllaxes, provide workers' compensation disability insurance, and contribute lo unemployment com- <br />pensalion of each 'employee." I abo understand my failure to abade by these lavrrs mey subjecl me to serious financial risk. <br />--.r2-2I L4l . t unaerstaM under Califomia conlrac{ors' Stale Liconse Law, an Owner-Builder who builds singlo-family rBsktontiat <br />strudures cannol legally build them with the intent to offurthem for sale, unless a/ work b performed by licensod subcont-ao <br />tors and the number of strudures does not exceed fourwithin any calendar years, or all of the work is periormed under contrad <br />with a licensed general building Contractor. <br />-?ttC ,n 8. I understand as an ovvner-Builder if I sell the property for which this permit b bsued, I may be hotd liaue for any finan- <br />cial dr personal injuries sus ained by any subsequent owne(s) that result ftom any htent corlsfucti6n defects in the wortman- <br />ship or materials.