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CITY OF SANTA ANA Planning and Building Agency,,,J i Dear Property Owner: Planning b Building Agency Building Safety Division 20 Civic Center Plaza P.O. Box 1988 (Ma-19) Santa Ana, CA 92702 (714)6476800 - vwvw.santa-ena.org NOTICE TO PROPERTY OWNER An application for a building permit has been submitted in your name specified at Q_n7 S Flower St. Santa Ana. CA 92703 We are providing you with an Owner -Builder A responsibilities and possible risk you mayincu J Approved FOR PERMIT ISSUANCE A Pt- 14 C6C 24, SIM s er IDo-HE GOLDEN CRT`' s FOUNDED 1869 Date. listing yourself as the builder of the property improvements cknowledgment and Information Ven r by having this permit issued in your ion Form to make you aware of your names as the Owner -Builder. 40 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 unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEGMENT AND VERIFICATION OF INFORMATON DIRECT70NS: Read and initial each statement below to signify you understand or verify this informadOne understand a frequent practice of unlicensed persons is to have the property owner obtain an 'Owner- Builder' build- ing pb000v that erroneously implies that the property owner is providing his or her own labor and material personally. I, as anunes sustained by an unlicensed person and Owner -Builder, may be held liable and subject to serious financial risk for any inj his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. am willfully acting as an Owner=Builder and am aware of the limits of my insurance coverage for injuries to workers on my prol>- env �� 1 .,.,riaKranri n"iidinn permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 4�3. I understand as an "Owner -Builder" I am the responsible party of record on the pe ft. 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. i aJY4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 7� 5. I understand if I employ or otherwise 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. 6. 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 cory-)m pen&%ion of each "employee.' I also understand my failure to abide by these laws may subject me to serious financial risk. Aw" 7. I understand under California Contractors' State License Law, an Owners -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontrao- tors and the number of structures does not exceed four within aiiy calendar years, or all of the work is performed under contract with a licensed general building Contractor. 8. I understand as an OwnerwBijilderit I sell the property for which this permit is issued, I may be held liable for any finan". cor personal injuries sustained by any subsequent owner(s) that resultifrom any latent construction defects n the workman- ship or materials.