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Home My WebLink About2833 S Fairview St Unit# F - Misc. Permit/gl1ooo83 MAYOR MiguelA. Pulido MAYOR PRO TEM Michele Martinez COUNCILMEI\,1BERS P. David Benavides Vicenle Sarmienlo Jose Solorio Sa Tinajero Juan Villegas CITY OF SANTA ANA PLANNING & BUILDING AGENCY 20 Civic Center Plaza P.O. Box I 988 . Santa Ana, California 92702 www.santa-ana.or9lpba NOTICE TO PROPERTY OWNER Dear Propefty Owner: An application for a building permit has been submitted in your name listing yourself as the builder ol the property rmp vements sp ecified at o CITY [,,1ANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL N4aria D. Huizar A 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 OwnerBuilder. We will not issue a building permit until you have read, initialed your understanding ol each provision, signed, and returned this {orm 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 ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Bead and initial each statement below to signity you understand or verify this information. 'Ht - l. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "OwnerBuilder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. l, as an Owner-Builder, may be held liable and sub.iect to serious financial risk lor 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 acling as an Owner-Builder and am aware ol the limits of my insurance coverage lor injuries to workers on my property. @r. I understand building permits are not requlred to be signed by property owners unless they are responsible lor the construction and are not hiring a licensed Contractor to assume this responsibility. @r. I understand as an "ownerBuilder" I am the responsible party of record on the permit. I understand that I may protecl myself f rom potential financial risk by hiring a licensed Contractor and havlng the permit filed ln his or her name instead ol my own. fuO I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. fu I understand if I employ or otherwise engage any persons, other than Calilornla licensed Contractors, and the total value ol my construction is at least live hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and lederal Iaw. @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 conlribute to unemployment compensation ol each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. &', I understand under California Contractors' State License Law, an Owner-Builder who builds single{amily residential structures cannot legally build them with the intent to offer them for sale, unless a//work is performed by SANTA ANA CITY COIJNCIL vsarm'enlo@saFta ana oromou do@sanh ana.oro lMayor Pro Tem, Ward 2 n man nez@sanra-ana oro is.lo.io@sanra.ana oro P. Dav d Benavdes dbenavdes@santa.ana.o.o ivilleoas@sanla-ana.oro slrnaE.o@santa-ana.oro licensed subcontractors and the number of structures does not aiceed four within any calendar years, or all ol the work is performed under contract with a licensed general building Contractor. @-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 financial or personal injuries sustained by any subsequent owne(s) that result from any latent construction delects in the workmanship or materials. 'W_9. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division oJ lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. '&-'to fiE pa.tv address: I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am leg all nd f inancially res nsible for proposed construction activity at the f ollowin UN tr --1() fu,.1 agree thal, as the party legally and financially responsible lor thls proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. -fu, I agres to notify the issuer of this lorm immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. lf you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil coud. lt is also important for you to understand that if an unlicensed Contractor or employee of that individual or lirm is injured while working on your property, you may be held liable tor damages. lf you obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible for verilying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. form notarization, or other verification acceDtable to the aoencv is reouired to be Dresented when the Dermit is issued to verifv the Dropertv owner's sianature- Signature of Property Owner Date AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which Iunderstand is my personal responsibility, I hereby authorize the iollowing person(s) to act as my agent(s) lo apply for. sign, and file the documents necessary to obtaln an Owner-Builder Permit for my project. Scope of Construction Prolect (or Description of Work) Project Location or Address Name of Authorized Agent Address of Authorlzed Agent I declare under penalty of perjury that I am lhe propeny owner for the address listed above and I personally filled out the above information and certify its accuracy. Property Owner's Signature Dale Print Name of Owner Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature- SANTA ANA CITY COUNCIL moulldo@sanra.ana.or. lvlayor Pro Tem. Ward 2 m mart,nez@sanla.ana oro V cente Sar.n erto vsarm enlo@sanla.ana.oro isoloio@sanla-ana.oro Belore a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. A/ote.' A copv of the DroDertv owner's driver's license. Print name ol Own" Phone Number ol Authorized Agent: P Dav,d Benavd€s Jlan villegas SalTnaiero Ward 4 Ward 5 Ward 6 dbenavdes@sanla.ana.ord ivilleoas@san€-anaoro gEaierc@$!.la:@a,g!9