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Home My WebLink About2106 1%2 W Eleventh St - Misc. PermitI\,,1AYOR MiguelA. Pulido MAYOR PRO TEM Michele Martinez COUNCILMEMBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajerc Juan Villegas CITY MANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar CITY OF SANTA ANA PLANNING & BUILDINC AGENCY 20 Civic Center Plaza P.O. Box I988 . 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 d.66, \ L L_l_€l\( t &**{x t$,".a 0x aa>r(71 We are providing you with an your responsibilities and poss ilder Acknowled me rmation Verification F to make you aware of ible 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 ACKNOWLEDGMEN T AND VERIFICATION OF IN FORMATON C7IO/VS; 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' lng pe rmit 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 of the limits of my insurance coverage for injuries to ers on my property 2. I understand building permits are not required to be signed by property owners unless they are responsible for nstruction and are not hiring a licensed Contractor to assume this responsibility. 3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may ect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name ad of my own 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license mbers on permits and contracts S. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the otal value of my construction is at least five hundred dollars ($500), including labor and materials, I may be consi dered an e ployer" under state and federal law 6. Iunderstand if Iam considered an "employer" understateand Federal law, I m ust register with the state and eral government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation of each "em ployee." I also understand my failure to abide by these laws may subject me to serious financial risk 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family idential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by SANTA ANA C IY COUNCIL rrfllrda@s!!!4a!a!!s Mayor Pro Tem, Ward 2 mmanr.e2@sanla-ana o.o Vicente Sarmiento vsamlento@santa-ana.oro isgE!9@93!E:4a.sg P Oavrd Benavides db€navides@sanla'6na oro vrlleoas@s3ola ana.oro / a/ 78sf7 stinaierolasanta€na.oro licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is ed under contract with a licensed general building Contracto? 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any cial or personal injuries sustaine d by any subsequent owner(s) that result from any latent construction defects in the manship or materials 9. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue e, the United States Small Business Administration, the California Department of Benefit Payments, and the Cal ornia Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board CSLB ) at 1 -800-321-CSIB (2752\ or www.cslb.ca.qov 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 legally and financially responsible for proposed construction activity at the following address 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by a licable 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 rma tion I have provided on this form Licensed contractors are regulated by Iaws 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 court. lt 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 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. lssued fo the owner's nature, Signature of Property Owner Date: a- Print name of Owner 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. Project Location or Address; Name of Authorized Agent Address of Authorized Agent: Phone Number of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above jnformation and certify its accuracy. Property Owner's Signature Date Print Name of Owner: Note: A copy of lhe owner's driver's license, form notarization, or other verilication acceptable to the agency is required to be presented when the permil is issued to verify the propedy owner's signature. ir -,,1j,: r. rAr,tir.,-:r,:,i:! .rfl.,...irr; :'r't ' ,.: ..'.'r SANTA ANA CITY COUNCIL mo!lido@sanla ana.oro Mayor Pro Tem, Ward 2 mrmarllnez@sanla-6.a.oro Vrcente Samienlo vsarmrenro@sanla-ena oro so or o@sanla-a.ts oro P Davd Benavides dbenav des@sanla ana o.o ivilleoaslasanla a.aora sr nalero@sanla-ana.oro 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. ,Vote: A copv of the propertv owner's driver's license, form notarization. or other verification acceptable to the aoencv is required to be presented when the permit is Scope of Construction Project (or Description of Work):_