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Planning & Building Agency ' Buildlng Safety Division 20 Clvic Ccntcr Plaza P.O. Box 1988 (ii-{g} Santa Ana, CA 92702 (7141647{800 www,santa-ana,org APP-I3 CBC 2016 NOTICE TO PROPERW OWNER Dear Property Owner: An application for a bu as the the property improvements specified at OA,)AA 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 retumed 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 DrRECfrOilS.' Read and initial each sbtement below to signify you understand or verify this information. -'11 . I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builde/' build-'ffil y'ermitthat enoneously implies that the property owner is providing his or her own labor and material personally. l, as an 5/ner-Builder, 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 homeowne/s insuranoe may not provide @verage 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- erty. nderstand building permits are not required to be signed by prope$ owners unless they are responsible f6r the and are not hiring a licensed Contractor to assume this responsibility. /,1 ILM. I understand as an'Owner-Builder" lam the responsible party of record on the permit. I understand that I may protect @y#tt from potentialfinancial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. ,/) IN-A I understand Contractors are required by law to be licensed and bonded in Califomia and to list their license numbers U6dermits and contracts. /.) [/LS. t understand if I employ or othenrise engage any persons, other than Califomia licensed Contractors, and the total Ktarte of my construction is at least five hundred dollars ($5001, including labor and materials, I may be considered an "employef under state and federal law. @rU I understrand if I am considered an "employe/' under state and Federal law, I must register with the state and federal (odmment, withhold payrolltaxes, provide workers'compensation disability insurance, and contribute to unemployment com- pensation of each 'employee." I also understand my failure to abide by these laws may subject me to serious financial risk. OL, I understand under Calibmia Contractors' State License Law, an Owner-Builder who builds single-f;amily residential Hr{ctures cannot legally build them with the intent to offer them for sale, unless allwork is performed by licensed subcontrac- tors 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 generalbuilding Contractor. ..\ Ah. 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- c$1y'r personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman- ship or materials. in v