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Home My WebLink About1010 N Fairlawn St - Misc. Permit/o/?rzco I,l!AYOR l\,Iiguel A. Pulido I,AYOB PBO IEM Michele N,4artinez COUNCILMEMBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CIry 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 improvements specif ied at \c\o N. Fo,\-dul n GI. S"u+o An- CA 121 CITY MANAGEB Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL l\,4aria D. Huizar \03 We are providing you with an Owner-Builder Acknowledoment and lnformation Verification Form to make you aware ol your responsibililies 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 olficial address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNEF'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signity you understand ot verily this information. 7-.(<' f . f understand a lrequent practice o, unlicensed persons is to have the property owner obtain an "OwnerBuilder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serlous financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. lvly homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware ol the limlts of my insurance coverage for injuries to workers on my property. .2. I understand buildin g permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. {Sg f understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may Drotect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. aS o. , understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. &u. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value ol my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. frU. , understand if I am considered an "employei' under state and Federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation of each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. j S z. t undersland under California Contractors' State License Law, an Owner-Builder who builds singlejamily residential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by SANTA ANA CITY COUNCIL moulido@sanra ana.oro lvlayor Pro Tem, Ward 2 m han ne2(6sarta-ana.oro Vrcente Sa.fiienlo vsarmrenlo@sanla-ana.oro lsolor o@sanla ana oro P David Benavides dbenav des@sanra.ana.oro ivrlleoas@santa-a.a.oro stina 610@santa-ana.oro An application for a building permit has been submitted in your name listing yourself as the builder of the property licensed subcontractors and the number of structures does not exceed four wjthin an5' calendar years, or all of the work is pertormed under contract wilh a licensed general building Contractor. / f\ a. t understand as an Owner-Builder if I sell the property tor which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or materials. 1_Lg. f understand I may obtain more information regarding my obligations as an "employer" lrom the lnternal Revenue Service, the United States Small Business Administration, the Calilornia Department of Benefit Payments, and the Calitornia Division ol lndustrial Accidents. I also understand I may contact the Calilornia Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or rvww.cslb.ca.oov lor more information about licensed conlractors. 7-ft .10. lam aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legal ly and financially,//n t r.,,/ I responsibl q t'd'fif,-Tff '"ff t\)"4"" U trb' q Iollowing address: /0 o\r.l &r', I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. {_&l Z. I agree to notify the issuer of this lorm immediately of any additions, deletions, or changes to any ol the information I have provided on this lorm. Licensed contraclors are regulated by laws designed to protect the public. ll you contract with someone who does not have a ticense, the Contractors' State License Board may be unable to assist you with any rinancial 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 nol those Contractors are properly licensed and the status of their workers' compensation lnsurance 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 lor issuing the permit. Notei A copv of the Dropertv owner's driver's license, torm notarization,or other verification acceDtable to the aoencv is reouired to be Dresented when the Dermit is issued to verifv the Dro owner's sianature. Signature of Properly Owner Date: O5 -/ O 1 9 Print name of Owner 4 obi"l" R otz AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Nolice to Property Owner. the execution ot which I understand is my personal responsibility, I hereby authorize lhe following person(s) to act as my agent(s) to apply for, sign, and tile the documents necessary to obtain an Owner'Builder Permil for my project. Scope ol Construction Project (or Description of Work) 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 inlormation and cerlify 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 verity the property owner's signature. SANTA ANA C]TY COUNC L 4qrlr.d!@la!la:a!!!I! l\rayor Pro Tem, Ward 2 mman nez@sanra-ana.oro v.ente Samienro vsarm ento@sanla.ane oro solorio@sanla ana o.o P. Oavd Benav des d!e!a!ides@!a!E:s!i ivilledas@santa a.a.oro strnaiero@sanla ana.oro Print Name o, Owner: