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Planning & Building Agen'cy <br />Building Safety Division <br />20 Civic Center Plaza <br />P.O. Box 1988 (M-19) <br />Santa Ana, CA 92702 <br />(714) 647-s800 <br /> <br />APP-13 CBC 2016 <br />Dear Property Owner <br />NOTICE TO PROPERTY OWNER <br />d in ame listing yourself as the builder of the property improvementsAn applicati <br />specified at <br />on for a buildin pe rmit h bee ubmig <br />O i:-r) <br />We are providing you with an Owner-Builder Acknowledqment and lnformation Verification Form to make you aware of your <br />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 this <br />form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, <br />obtain the praor approval of the permitting authoraty. <br />OWNER'S ACKNOWLEGMENT AND VERIFICATION OF INFORMATON <br />DIRECTIONS: Read and initial each statement below to signify you understand or verify this intormation. <br />'Ma I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Buildel' build- <br />fng permit that erroneously implies that the property owner is providing his or her own labor and material personally. l, as an <br />Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and <br />his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I <br />am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my prop- <br />erty. <br />{1 I <br />bu-r. I understand building permits are not required to be signed by property owners unless they are responsible for the <br />'construction and are not hiring a licensed Contractor to assume this responsibility. <br />W_9. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect <br />inyself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my <br />own. <br />4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers <br />on permits and contracts <br />'WU I understand if I employ or otheruise engage any persons, other than California licensed Contractors, and the total <br />I 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 />Iot <br />Wa I understand if I am considered an "employer" under state and Federal law, I must register with the state and federal <br />rgovernment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment com- <br />pe nsation of each "em ployee." I also understand my failure to abide by these laws may subject me to serious financial risk <br />7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential <br />S ructures cannot legally build them with the intent to offer them for sale, unless a// work is performed by licensed subcontrac- <br />tors and the number of structures does not exceed four within any calendar years, or all of the work is performed under contract <br />with ai licensed general building Contractor. <br />ltl <br />W-A I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any finan- <br />'cial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman- <br />ship or materials.