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MAYOR <br />Mrguel A. Pulido <br />MAYOR PRO TEM <br />SalTinajero <br />COUNCILMEMBERS <br />Angelica AmezcLra <br />P David Eenavides <br />Michele i,4arlinez <br />Roman Reyna <br />Vincenl F Sarmienlo <br />CITY I\,1ANAGER <br />David Cavazos <br />CITY ATTORNEY <br />Sonia R Carvalho <br />CLERK OF THE COUNCIL <br />Maria D HLrizar <br />CITY OF SANTA ANA <br />PLANNINC & BUILDING ACENCY <br />20 Crvrc Centea Plaza <br />P O. Box 1988 . Santa Ana. Calrlornia 92702 <br />www.5anta-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 yourself as the builder of the property <br />improvements speciried at zq, L t Do-l wles g\=.+S"^A^-n L1a-g <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 form 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 ACKNOWLEGMENT AND VERIFICATION OF INFORMATON <br />DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. <br />-d\Vl . t understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" <br />building permat that erroneously implies that the property owner is providing his or her own,abor and material personally. l, <br />as an Owner-Builder, may be held liable and subject to serious financial risk for any inJuries sustajned by an unlicensed <br />person and his or her employees while working on my property. l\4y 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 />-pM t understand building permits are not required to be signed by property owners unless they are responsabte for <br />the construction and are not hiring a licensed Contractor to assume this responsibility. <br />M. t understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may <br />protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name <br />instead of my own. <br />M t understand Contractors are required by law to be licensed and bonded in California and to list their license <br />numbers on permits and contracts. <br />Nltr'S. t understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the <br />total 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 />0WO. t understand if I am considered an "employer" under siate and Federal law, I must register with the state and <br />federal 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 subiect me to <br />serious financiai risk. <br />LM ,understand under California Contraclors' State License Law, an Owner-Builder who builds singteJamily <br />residential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by <br />licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is <br />performed under contract with a licensed general building Contractor.