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lr o t:. <br />a-?:: <br />Planning & Bullding Agoncy <br />Bulldlng Safety Divl3'ron <br />20 Clvlc Center Plaza <br />P.O. Box 1988 (M-19) <br />Senta Ana, CA 9z,02 <br />0r4) 647-5800 <br />www.3anta-ana.org <br />APP-I3 CBC 2015 <br />NOTICE TO PROPERTY OWNER <br />Dear Property Owner: <br />An applica tion for a buildin g perm it has been submitted in your name listing yourse lf as the builder of the rm ents <br />specified at <br />We are providing you with an Owner-Builder Acknowledoment and lnformation Verification Form to make you aware of your <br />responsibilities and possible risk you may incur by having this pormit issued in your names as the Owner-Builder. <br />We will not issue a buiHing permit until you have read, initialed your understanding of each provision, signed, and returned this <br />fom to u6 at our official address indicated. An agent of the owner cannot execute hls notlce unless you, the property owner, <br />obtain the prior approval of the permitting authority. <br />OWNER'S ACKNOWLEGiiENT ANO VERITICATION OF INFORMATON <br />: Re'.l eN lntdaloacr, statemorrt 6erow to sEaW you uaderctd,nd or vetw thls lntonnatlon. <br />1. I understand a frequent practice of unllcensed persons is to have the property owner obtain an "Owner€uildei build- <br />ing pamit that enonoously imdi€s lhat the property owller is providing his or her or n labor and material peGonally. l, as an <br />O*ner+uilder, may be h€ld liablc and subject b serious financiat risk for any injuries sustained by an un[c6nsed person and <br />his or her employees whle worklng on my property. My homeowneds insuralnce may not ptovide coverage fo( tiose injuries. I <br />am wilFJlly 4t'ng as an OwnerSuilder and am aware of the limits of my insuErnce coverage for injuries to workers on my prop <br />eftv. /N <br />-L2. I understand building p€rmits are not required b be signed by propcrty owners unless they ar€ responsible for the <br />con9rc{ion and are not hin'ng a lbensed Contracbr to assu.rE thb responsibllity_ <br />d,l, t uno.ot"nd as an 'Orvner-Buitdsr I am the respongble party of record on th6 pemit I undeGtand that I may pmtect <br />mytelf frcm potential fnancial risk by hiring a licens€d Contractor and having the pem[ filed in his or her name insteadof myo*.a' <br />0/ a. t unaerstand Contrac{ors are rtquir€d by law to be licansed and bonded in Califomia and to list their license numbers <br />on permlts <br />{,, <br />and contracts. <br />understand if I employ or otherwise engEle any personst other than Caliirmla [censed Contractors, and the total <br />value of my construdion ts at l€as( five hundrcd dolars ($500), inctud ing labor and materials. I may be considercd en'ettl.ryef <br />OL. , <br />under state and federal law. <br />urdersbnd ifl am consirered an'€mployef under 6tate and Federal law, I must register with the shte and lederal <br />govemment,wlthhold payroll taxes, provile workers' compensauon disability insurance, and contsibute to unemdoymenl com-p€nsgtion <br />d,,of eacfi "empbyee.' I abo understand my failure b abide by these laws may subject me to sefbus financial risk. <br />understand under Cdifomia Confactors' Srtate Licens€ Law , an Ownor+u der who builds single-family residentialstructjres cannot legally buiH th€m with the intent to ofrer them ior sab, unbss a/ work is perforned by licensed subconfac- <br />brs and number of shuctures do€s not oxceed fout within any calendar years, or all of he *ork b perbImod under contractwithgeneral building Cont'actor. <br />I understand 6 an Osmer€uiHer if I sell the property for which this permit is issued, I may be held liable lor any finan-ciel or p€rsond injuries suslahed by any su <br />ship or rnaEriab. <br />bsequ€nt owne(s) that result from any lateril conslruction defects in lhe workma rr