HomeMy WebLinkAbout2025 S Cedar St - Misc. Permit/o/2a97
MAYOR.
Iuiguel A. Pulido
MAYOR PRO TEM
Michele lvartinez
COUNCILMEMBERS
P. David Benavides
Vicente Sarmiento
Jose Solorio
SalTinajero
Juan Villegas
ACTING CITY MANAGER
Gerardo lvlouet
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
Maria D. Huizar
CITY OF SANTA ANA
PLANNINC & BUILDING AGENCY
20 Civic Center Plaza
P.O- Box I 988 . Santa Ana, California 92702
www.santa-ana.orglpba
NOTICE TO PROPERTY OWNER
Dear 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 ., ^+oas 3oA< /,/z C=eerz ST S A
We are providing you with an Owner-Builder Acknowledqment 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 returned
this form to us at our official address indicated. An agent of the owner cannot execule this notice unless you, the property
owner, obtain the prior approval of the permitting authority.
ER'S ACKNOWLEDG N D RIFI
TIONS: Read and initial each statement below to signify you understand or verify this information.
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder'
permit that erroneously implies that the property owner is providing his or her own labor and material personally. l,
AS n Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed
pe and his or her employees while working on my property. My homeowner's insurance may not provide coverage for
th ose njuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to
rk
I understand building permits are not required to be signed by property owners unless they are responsible for
ruction 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
myself from potential financial risk by hiring a licensed Contractor 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 Californla and to list their license
NU on permlts and contracts
lue
understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an
under state and federal law.
. Iunderstand if Iam considered an "employer" under slate and Federal law, I must register with the state and
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
UN oyment compensation of each "employee.' I also understand my failure to abide by these laws may subject me to
financial risk.
. I understand under California Contractors' State License Law, an Owner-Builder who bullds single-family
tial structures cannot legally build them with the intent to offer them for sale, unless a//work is performed by
SANTA ANA CITY COUNCIL
moulido@sanla-ana oro
M€yo. Pro Tem, Ward 2
rirmanlnez@sanla-ana.o.o
v cenre Sarmienlo
vs6mlento@santa-ana oro isolo o@s6nla'E.a.oro
P David Benavides
dbenavides@s.nla-ana.do ivillooas@sanla-ans.oro sli.aiero@sanla anaorq
on my property.
lice subcontractors and the number of structures does not exceed four within any calendar years, or all of tl"D work is
med under contract with a Iicensed general building Contractor
8. I understand as an Owner-Builder if I sell the prooerty for which this permit is issued, I may be held liable for any
al or personal injuries sustained by any subsequent owner(s) that resull from any latent construction defects in the
anship or materials.
Cal
. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue
, the United States Small Business Administration, the California Department of Benefit Payments, and the
ia Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board
) at 1-800-321-CSLB (2752)or www.cslb.ca.qov 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
rty legally and financially respons ible for pro construction activity at the followi nOo>S C a9r
l',1.1a gree that, as the party legally and financially responsible for this proposed construction activity, I will abide by
Iicable laws and requirements that govern Owner-Builders as well as employers
I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
ion I have provided on this form.
Li sed contractors are regulated by laws designed to protect the public. lf you contract with someone who does not
have a llcense, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain
as a resull of a complaint. Your only remedy against unlicensed Contractors may be in civil court. lt is also imporlant 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 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.
Wi;re a building permit can m be completed and signed by the property owner and
ned to the agency ibr rl tn e it. /Vofe; A copv of the oropertv owner's driver's license.
notarization or er it
issued ,o the
Signature of Property Owner Date: S
Print name of Owne YI w$rr*e,at TnC
AUTHORIZATION OF AGENT TO CT ON PROPERry OWNER'S BEHALF
Excluding the Notice to Property Owner, lhe execution of whjch I understand is my personal responsibility, I hereby authorize the
following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my
project.Add *t"",. Ov\ $.>..s:\-rw3 \nc,vtq Nec.i.,l Aou a,rd -E wcylr. r €ed
Scope of Construction Project (or Description of Work)
Project Location or Address 5olS >oDs /1 6lsde., S+ S A
Name of Authorized Agent;
Address of Authorized Agent:(
L
oc)
I declare under penalty of perjury for the address listed above and I personally filled out the above
s /zr/r&Property Owner's Sig nature:Date:
Print Name of Owner:
Note: A copy of the
t-,1fJnC.
s s ot other verification acceptable to the agency is required to
be presented when the permit is issued to the owner's signature.
PLhkrwP5l/Co!nleiAclrvity^ssenuyS,lrsrNoti.e !o ProFeny Fom 03-14-?01 6
SANTA ANA CITY COUNCIL
e pro e own
qoul dolasa.la-ana oro
M chele Marlinez
Mayor P.o T€m Ward 2
mimaninez@santa-ana.oro
vicenle Sarmiento
6armie.ro@santa{M.oro isolo.io@santa€na.oro
P David Benavdes
dbe.avrdes@sanla-a.a ora ivilieoas@sanl6-aoa oro
Sal Tinajerc
slinai€ro@sEnra-6na.o.o
z,ft*
Phone Number of Authorized Agent:
information and certify its accuracy.