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Home My WebLink About1405 E Avalon Ave - Misc. Permit7 MAYOR MiguelA. Pulido MAYOB PRO TEI\,4 Michele Martinez COUNCILMEMBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinaiero Juan Villegas CITY I\,4ANAGEB RaulGodinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar CITY OF SANTA ANA PLANNINC & BUILDINC ACENCY 20 Civic Center Plaza P.O. Box 1988 . Santa Ana, California 92702 www.santa-ana.or9 pba NOTICE TO PROPERTY OWNER Dear Property Owner: An application lor a building permit has been submitted in your name listing yourself as the builder ol the property V'K'"I?ti'9"A Arr,lrn lv* Soni-A-u 9Zror moll do@santa ana oro Mayor P.o Tefi, Ward 2 m m.rtrne2@sanla ana.oro Vrcenle Sarmienlo vsa.nienlo@santa.ana.oro isolor o@sanla.ana.oro P Oavrd Benavides dbenav des@santa'ana.oro 7\- ' We are providing you with an Owner-Builder Acknowledoment and lnformation Verificatlon Form to make you aware ol your responslbilities 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 of each provision, signed, and returned this rorm 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 ACKNOWLEDG MENT ANO VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand or verify this intormation, I t",-V I . 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 subject to serious financial risk for 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 acting as an Owner-Builder and am aware ol the limits of my insurance coverage for injuries to workers on my property. V'- z. t understand building 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. W-5. I understand as an "Owner-Buildea' I am the responsible party ol record on the permit. 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. u- 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license nurnbers on permits and contracts. L/.v 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value ol my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. C.- O f 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 compensation ol each "employee." I also understand my lailure to ab de by these laws may subject me to serious f inancial risk. U\Z I understand under California Contractors' State License Law, an Owner-Builder who builds singlejamily residential structures cannot legally build them with the intent to offer them for sale, unless a//work is performed by SANTA ANA CIry COUNCIL ivilleoas@sanla'anaoro slnaero@sa.taana.oro licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is performed under conlract with a licensed general building Q.ontractor. l- U. , understand as an Owner-Builder if I sell the property tcr 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 defects in the workmanship or materials. ^g. t understand I may obtain more inlormation regarding my obligations as an "employea'{rom the Internal Revenue Service, the United States Small Business Administration, the California Department ol Benelit Payments, and the California Division of 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. 10. I am aware of and consent to an Owner-Builder building permit applied for in my name. and understand that I am the party ly and {inancia u:"oo n efo ,l proposed struction ity a hef lowing 9^zoaddresat/ -t-.1N _1 1. I agree that, as the party legally and financially responsible lor this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. _12.1agree to notify the issuer of this form immediately of any additions, deletions, or changes to any ol the information I have provided on this lorm. 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 ol a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. lf you obtain a permit as OwnerBuilder and wish to hire Contactors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before 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. Ivolej A coDv of the proDertv owner's driver's license, lorm notarization, or other veritication acceptable to t aoencv is reouired to be presented when the permit is s re. A-,-Signature of Property Own Dale 5 /s t0, Print name of Owner lf D\, AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) lo acl as my agent(s) to apply ior, sign, and file the documents necessary lo obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work) Project Location or Address Address ol Authorized Aoent Phone Number of Authorized Agent ldeclare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Property Owner's Signature Date Print Name of Owner Note: A copy ol the owner's driver's license, form notarization, ot other verification acceptable to the agency is required to be ptesented when the permit is issued to verify the property owner's signature. SANTA ANA C TY COUNCIL mo.l,doadsa.ta ana.oro rvayor Pro Tem. Ward 2 E!oani!e?@sa!lr:a!@ vsarm ento@sanra ana oro l$lsre@.lalla:ana4Iq P Davrd Aenavides dbenavdes@sanra ana.oro i!ne9as@!afl!:a!@ sr nalero@sa.ra ana oro I Name ol Authorized Aoenl: