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Home My WebLink About1100 W Warner Ave - Misc. Permit (2)/ot%k"n?*^", Cynthia J. Kurtz CITY ATTORNEY Sonia R. Carvalho CLERK OF IHE COUNCIL N4aria O. Huizar CIry OF SANTA ANA PLANNING & BUILDING AGENCY 20 Civic Center Plaza P.o. Box 1988. Sanra Ana, California 92702 waM/v. san ta-ana. orq / pba NOTICE TO PROPERTY OWNER An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at oa rJ.ujac}Je Jr,A L We are providing you with an m n rm rifi nF rm 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 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 D\RICTIONS: Read and initial each statement below to signify you understand or verify this information. xl7n-f. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" building y'gfft tnat erroneously implies that the property owner is providing his or her own labor and material personally. l, as an Owner- Buifder, 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. l\,4y homeowner's insurance may not provide coverage for those injuries. I am willfully acting an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my propertya -2 . I understand building permits are not required to be signed by property owners unless they are responsible for the ction and are not hiring a licensed Contractor to assume this responsibility.n -3. lunderstand as an "Owner-Builder" lam the re sponsible party of record on the permit. I understand that I may protect myself potential flnancial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on its and contracts -5. I understand if lem ploy or otherwise engage any persons, other than California licensed Contractors, and the total value of nstruction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state federal law \6. I understand if I am considered an "em ployer" under state and Federal law, I must reqister with the state and federal nment, withhold payrolltaxes, provide workers' compensation disability insurance, and contribute to unemployment m ensation ofeach "employee." lalso understand my failure to abide bythese laws maysubjectmeto serious financial risk \ 7. I understand under California Contractors' State License Law , an Owner-Builder who builds single-family residential res cannot legally build them with the intent to offer them for sale, unless a// work is performed by licensed subcontractors and e number of structures does not exceed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. -h& ' 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 p(y&pal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or mbtcfials. SANTA ANA CITY COUNCIL mourido@sanla'ana oro MayorPro Ten Ward 2 m ma,i ne2@sanla-ana oro Vrcente Sarh ento !samienlo@sa.ta ana.oro MAYOR Miguel A. Pulido MAYOR PRO TEIlI Michele Martinez COUNCILMEI\,1BERS P David Benavides Vicente Sarmiento Jose Solorio Sal Tinajero Juan Villegas Dear Property Owner: isolorio@sanla-ana.oro P Davd B€navides dbenavidesaosanta-ana oro v e.as@sanla-an, oro sl nalero6sanra'a.a oro \/ -{* ,undersland I may obtain more information regarding my obligations as an "omployer" from the lnternal Revenue Service, the tly'itpld States Small Business Administration, the California Department of Fenellt Payments, and the California Division of lndustrial Atdidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or for more information about licensed contractors 0. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party v nanciall v resoonsibD rJ.ble ro osed con ruction acti at the llowing 1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all ble laws and requirements that govern Owner-Builders as well as employers. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have ided on this form icensed 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 com plaint. Your only remedy against unlicensed Contractors may be in civil court. ltis also important foryou to understand that if an unlicensed Contractor or employee ofthat individual or llrm isinjured while working on your property, you may be held liable fordamages. lfyou obtain a permit as Owner-Builder 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. A/ole,' A copv of the proDeftv owner's driver's license. form notarization. or other verification acceotable to the aqencv is reouired to be presented when the oermit is issued to verifv the propertv owner's siqnature. Signature of Property Owner Date:\ t l'Z'17 Print name of Owne 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) to act as my agent(s) to apply for, sign, and flle the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work) Project Location or Address Name of Authorized Agent Address of Authorized Agent;_ Phone Number of Authorized Aqent: I declare 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 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 propefty owner's signature. P L in k:W P5'1 lCounterActivity/Assenr blyB ills/Noti0e lo Pro perty Forn) SANTA ANA CITY COUNCIL moulidolOsanta ana.oro Mayor ProTem Ward 2 m man nez@sanla a.a.oro vsarm enlorAsanla ana oro isolono@sanla-ana oro P. Dav d B.n6vides dbenavides@sanla-ana.oro iviXe9es@!!da:a!!.q st na ero@santa-6na oro Print Name of Owner: