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Home My WebLink About101100221 - Misc. Permit0034/ NiIAYOB MiguelA. Pulido N,4AYOB PRO TEN,l N,4ichele Martinez COUNCILI\,4EMBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY OF SANTA ANA PLANNING & BUILDING ACENCY 20 Civic Center Plaza P.O. Box 1988 . Santa Ana, California 92702 www.santa-ana.org / pba NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a buildin improvements specified at g permit has been submitted in r name listing yourself as the builder of the property 5t0 ^/WeareproVidingyoUwithantomakeyoUawareol 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 ol each provision, signed, and returned 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 ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signity you understand or verify this intormation. _1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Buildea' 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 linancial risk lor any injuries sustained by an unlicensed perso and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those njuries. I am willlully acting as an Owner-Builder and am aware of the limits of my insurance coverage lor injuries to work rs on my property nderstand building permits are not required to be signed by propeny owners unless they are responsible for the struction and are not hiring a licensed Contractor to assume this responsibility. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may mysell from potential financial risk by hiring a licensed Contraclor and having the permit filed in his or her name of my own. . I understand Contractors are required by law to be licensed and bonded in California and to list their license nu rs on permits and contracts 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the I value ot m y construction ls at least five hundred dollars ($500), including labor and materials, I may be considered an pl yer" under state and federal law . Iunderstand if Iam considered an "employer" under state and Federal law, I m ust register with the state and government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to UN ent compensation of each "employee." I also understand my failure to abide by these laws may subject me to CITY MANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carva ho CLERK OF THE COUNCIL Maria D. Huizar rns pl inancial risk. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family us ntial structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by SANTA ANA CITY COUNCIL moul do@santa'ana.oro Mayor Pro Tem, Ward 2 mimarnnez@sanla-ana.ord vsa.mienlo@sanra-ana.oro so10.o@sarra-ana.oro dbenavrdes@sa.E ana.oro iv lleoas@santa-ana o.o srinaiero@santa ana.oro "/)l1v'r L\t licens subcontractors and the number of structures does not exoeed^four within any calendar years, or all ot the work is perfo ed under contract with a licensed general building Contractor I understand as an Owner-Builder il I sell the property for which this permit is issued, I may be held liable for any lor personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the anship or materials 9. I understand I may obtain more inlormation regarding my obligations as an "employer" f rom the lnternal Revenue ice, the United States Small Business Administration, the California Department of Benefit Payments, and the lfo ia Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board S 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 legally nciall spo n ble fo ro sed struction activity at the Iollowing re . I agree that, as the party legally and financially responsible ror this proposed conslruction activity, I will abide by icable laws and requirements that govern Owner-Builders as well as employers gree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the mation I have provided on this lorm censed contractors are regulated by laws designed to protect the public. lf you contracl 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 court. lt is also important for you to understand that if an unlicensed Contractor or employee o{ that individual or firm is injured while working on your property, you may be held liable for damages. lf you obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible for verifying whether or not those Contractors are properly Iicensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by lhe property owner and returned to the agency responsible for issuing no or other verificati issued to the owner's Signature of Property Print name ol Owner Owner Date ,zt--,-</-t2 AUT RIZATION 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 Iollowing person(s) to act as my agent(s) to apply for, sign, and Iile the documents necessary to obtain an Owner-Builder Permit for my project. Scope ol Construclion Projecl (or Description of Work):_ Project Location or Address Name of Authorized Agent 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 inrormation and certify its accuracy. Prope(y Owner's Siqnature Date Print Name ot Owner Note: A copy ol 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 natu tl2Z- moul do@sanla'ana oro Mayor Pro Tem Waid 2 m madrnez@santa.ana.oro V'.enrc S.rm'enr. !ra!o!e!l!@ la:alr,alg isdlria@sa!.la:ala P Davd Benavides dbenav des@sanla-ana.o..ivilleoas@santa-ana oro qr.!aie!!@sa!.la:!!!.9a Note: A copv ot the propertv owner's driver's license, Address of Aulhorized Agent:_