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I T APP-13 CBC 2015 NOTICE TO PROPERTY OWNER Dear Property Owner: An applicati specified at r a buildino3:-7 pe rmit h been (- itted in your na e listing yourself as the builder of the property improvements 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 ofthe 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 DIRECTIONS: Read and initial each statement below to signity you understand or verity this information. 1 . I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" build- rmit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any iniuries sustained by an unlicensed person and his or her employees while working on my property. My homeowneis insurance may not provade coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my prop- 2. I understand build in g permits are not required to be signed by property owners unless lhey are responsible for the truction and are not hiring a licensed Contractor to assume this responsibility 3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect lf from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers rmits and contracts 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total of my construction as at least five hundred dollars ($500), includang labor and materials, I may be considered an loyer" under state and federal law. 6. Iunderstand if Iam considered an "employer" understate and Federal law, Imust register with the state and federal rnment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment com- sation of each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential ctures cannot legally build them with the intent to offer them for sale, unless a// work is performed by licensed subcontrac- nd the number of structures does not exceed four within any calendar years, or all of the work is performed under contract licensed general building Contractor. 8. 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- r personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman- ip or materials Planning & Building Agency Building Safety Division 20 Civic Center Plaza P.O. Box 1988 (M-19) Santa Ana, CA 92702 (714) 647-s800 www.santa-ana.org