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MAYOR <br />Miguel A. Pulido <br />MAYOR PRO TEM <br />Machele Martinez <br />COUNCILMEMBERS <br />P. Davad Benavides <br />Vicente Sarmiento <br />Jose Solorio <br />SalTinajero <br />Juan Villegas <br />CITY MANAGER <br />Raul Godinez ll <br />CITY ATTORNEY <br />Sonia R. CaNalho <br />CLERK OF THE COUNCIL <br />Maria D. Huizar <br />CITY OF SANTA ANA <br />PLANNING & BUILDINC AGENCY <br />20 Civic Center PIaza <br />P.O. 8ox 1988 . Santa Ana, California 92702 <br />www.santa-ana.org / pba <br />NOTICE TO PROPERW 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 prope(y <br />improvements snecified at g, <br />,42ac{-N UNi lT- + Z3{- <br />e[:. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" <br />milding permit that erroneously implies that the property owner is providing his or her own labor and material personally. l, <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 />C:Nr. , understand building permits are not required to be signed by property owners unless they are responsible for <br />the construction and are not hiring a licensed Contractor to assume this responsibility. <br />f1lf, I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may <br />irotect mysetf 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 />OM <br />' <br />understand contractors # [:ir],'d[tri;'rt,'u'b" ri"li*I$rho o <br />numbers on permits and eolrfads.: . . '.; . ,',:'.-t . .':\'.'.\.-\.' '.'. <br />onded in California and to list their license <br />.|,t <br />(M t understand if I emptoy or otherwise engage any persofrsig.til6f hhir Eitiiornia liictir,sid Contractors, and the <br />total value of my construction is at least five. hun{fed do.]lars (q{99). incf uding Lapqr.?nd m?lerials, I may be considered an <br />.employer" under state and federal law. 'l\ r'.'.I'i l i'' <br />M I understand if I am considered an "employer" unoe, stite arid r"oiii rai,,'iirrrtt 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 subject me to <br />serious financial risk. <br />l/16 I . I understand under California Contractors' State License Law, an Owner-Builder who builds single-fam ily <br />Eiidential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by <br />SANTA ANA CITY COUNCIL <br />mDUlidolosanla-ana.o.o <br />Mayor Pro Tem, Ward 2 <br />mimartineziosanta-ana orq <br />Vicente Sa.miento <br />vsarm e.10@sa.ta-ana.oro isoloio@sanla-ana oro <br />P. Oavd Benavides <br />dbenavides@s5nla-ana.oro iuX!9!s@s4E:eE slinaiero@santa-ana oro <br />T^-Pt XLru/c-. <br />We are providing you with an Owner-Builder Acknowledoment and lnformation Verification Form to make you aware of <br />your responsibiliiies 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 untit 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 ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON <br />DIRECTTONS: Read and initiat each statement below to signify you understand or verify this information.