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MAYOR Miguel A. Pulido MAYOR PRO TEM Vincenl F. Sarmlenlo COUNCILMEMBERS Angelca Amezcua P. David Benavides Michele Manhez Roman Reyna Sal Trna,ero Dear Prope(y Owner An application for a building perm improvements specified at I ta() CITY i'TqNAGER Davrd Cavazos CITY ATTORNEY Sonra R Carvalho CLERK OF THE COUNCIL Mana D. Huzar CITY OF SANTA ANA PLANNINC & BUILDINC ACENCY 20 Clvrc Center Plaza P.O Box 1968 . Sanra Ana. Calrfornra 92702 wwl^,.5anIa-ana.org pba NOTICE TO PROPERTY OWNER it has been submitted in your na 'l n -lh 3.Y6 t me listing yourself as the builder of the property B We are providing you with an Owner-Builder Acknowledoment and lnformation Verification Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your names as the Owner-Builder. We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unlesJ you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATI ON OF INFORMATON DIREC TIONS: Read and initial each statement below to signify you understand or verify this information. $f-unO"rstand a frequent practice of unlicensed persons is to have the property owner obtain an 'Owner-Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. L as an OwnerBuilder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuiies to workers on my property. the cons L, I understand as an 'Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. *0. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 4u I understand if I employ or otheruise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an"employer" under state and federal law. ?u I understand if I am considered an "employer' under state and Federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation of each "employee.' I also understand my failure to abide by these laws may subject me to senous financial risk. C?*'-7 I understand under California Contractors' State Llcense Law, an Owner-Builder who builds single-family teliOentiat structures cannot legally build them with the intent to offer them for sale, unless a// work is peiormed by licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. SANTA ANA CITY COUNCIL I understand building permits are not required to be signed by property owners unless they are responsible for truction and are not hiring a licensed Contractor to assume this responsibility vrlcsr t !blr.r. liaasr P.o Te, Wei ' \.sar'lre lo66anlB.e. @ MMan,.e:iA sr^rr sn3 ... A,!Eu.Os!nL-.8 60