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Home My WebLink About2624 N Towner St - Misc. Permit/o /?kttt [,1AYO;1 [4iquel A Pulioo IJAYOR PRO TEIV Michele fulartiiez COUNCILMEMBERS P Davrd Benavides Vrcenle Sarmrenlo Jose Solorro SalTrnajero Juan Villegas CITY MANAGER RaulGodinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar CITY OF SANTA ANA PLANNINC & BUILDINC ACENCY 20 Civrc Center Plaza P.O. 8ox 1988 . Santa Ana, Calrfornra 92702 w\/w.5anta ana.or9,'p5a 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 pfoperty improvements specified at 2624 N. Towner St. SanlaAna-CA-92706__- We are providing you with an OwnerBuilder Acknowledomenl and lnformation Vqrification Form to make you aware of your responsibrliiies and possiOtelGf,you rnay,ncur Oy naving this permit issued in your names as the Owner-Builder. \r/e will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned thrs form to us at our officiil address ind'icated. An agent of the owner cannot execute this notice unless you, the property owt]er, obtain the prior approval of the permitting authority OWNER'S ACKNOWLEDGME NT AND VERIF ICATION OF INFORMATON ! 1 . I understand a ireguent practice of unlicensed persons is to have the property owner obtain an 'Owner-Builder" UirrrOing permrt that erroneously implies that the property owner is providing his or her own labor and material personally. l, as an 6wner-Builder, may be tretO iiaOte 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 ihose injuries. I am willfu]ly ;cting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. / 2. I u,-rderstand building permits are not required to be signed by property owners unless they are responsible for fi,e construction and are not hiring a licensed Contractor to assume this responsibility' J 3. I understand as an 'Owner-Buildef' I am lhe responsible party of record on the permit.-l understand that lmay p-itect nrysclf from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name i|stead of my own. y' 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. ,/ 5 I understand if I employ or otherwise engage any persons, other than California licensed Conkactors, and the t,rilt *lu" o{ my construction is at least five nunoieJ ooltjrs ($500), including labor and materials, I may be considered an "employer" Ltnder state and federal law. / 6. I understand if I am considered an "employer" under state and Federal Iaw, I must register with lhe state and 6i"r.igorernr"nt, withhold payroll taxes, provide workers' compensation disability rnsurance, and contribute lo ,,-"="1ftJymentcompensationofeach"empioyee.'lalsounderstandmyfailuretoabidebytheselawsmaysubjectmelo serious financial risk ...:1_7 I undersrand under california contractors' state License Law, an owner-Builder who bullds single-family iJi Oontial structures cannot legally build them with the lntent to offer them for sale, untess a// work is performed by DIRECTIONS: Read and initial each statement below to signity you understand or verify this information. SANTA ANA CITY COUNCIL r.t.i olosnnra aM do \. e.es@*Jrr.e1a c:odr..rs'dr:s'asanG nri -ra t,n. |E,r Mn,1','ti lvhr!: P:i) Te. W3rd ? r\ c.2,L,L.7 'ii..r:r.a.1 crn !!aiE!9e.r4!E:38 3!2 lonfr t1lrcensed subcontractors and the number of structures does not exceed four within any calendat years, or all of the work isperformed under contract wrth a licensed general building Contraclor. ./ 8 l understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for anyfinancial or personal iniuries sustained by any subsequent ow;e(s) that resuli from any lateni conitruction defects in thelvorkmanship or materials. --',1-9 I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Seruice, the United States Small Business Administration, tnebaiifornii Departmenl of Benefit payments, and the Caltfornia 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 contracrors. J 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 legally.and financially responsible.for proposed construction activity at the following address: 2624 N. Towner St. Santa Ana CA. 92706 t/ 11.1agree that, as the party legallyand llnancially responsible for this proposed construction activity, lwill abide by all applicable laws and requirements that govern Owner-Builders as well as employers. y' 12. I agree to notify the issuer of this form immediately of any additlons, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws desagned 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 courl. lt is aiso important for you to understand that if an unlicensed Conlractor 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 Contaclors,-you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their wo.kers' 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. /Vote.. form no tarization, or other verification table to the aaencv rs to be ore sented when the Definit is issued fo VD the ow 'ss n Signature of Property Owner Date: 01/04/2019 Print name of Owner Loan Crawford AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I undersiand is my personal responsibility, I hereby aulhorize the lollowing person(s) to act as my agent(s) to apply tor. sign, and tile the documenti necessary to obtain ah Owner-i!uilder permit for myproject Scope of Constructioo Project (or Description oF Work)Remove and reolace existino roof at house and qaraqe ProJ cct Location or Address: 2624 N. Towner St. Santa Ana CA. 92706 Name of Authorized Agen t: Mike Zadeh Address of Authorized Ag ent 1415 E 17th. St. # 270 Santa Ana CA. 92705 I dcclare under penalty of perjury thal I am the property own r for the address listed above and I personally filled out the above rnformation and certify ils accuracy Prope(y Owner's Signalure Print Name of Owner: Loan Crawford Nole: A copy of th e owner's driver's license, form notarization, or othet veification acceptable to the agency is required to be presented when the permit is issued to verify lhe ptope,ly owner's signature. SANTA ANA CITY COI,JNCIL May.r ft6 Ten W6rd 2 lrr,rocsFia:ana_ql v.5re samenro r.rrmr.rloosait. an..l9 tro:919t&s!!!:!r!-!!q -: era!i.?s6<i :r.ar,.gtg -{!gu!aj4:1_s,j!-!,r._c *:i,s!.@!?IilE3larr! A copv of the Drooeftv owner's driver's license, Phone Number of Authorized Agent: 714 541-8011 Date: 0110412019