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Home My WebLink About1006 N Broadway - Misc. Permit/o/ zrrsf t\,'IAYOR LliguelA. Pulido l\,,lAYOR PRO TEM Michele Martinez COUNCILMEMBERS P. David Benavides Vicenle Sarmienlo Jose Solorio Sal Iinajero Juan Villeqas CITY ITANAGEB Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL N,laria D. Huizar CITY OF SANTA ANA PLANNIN6 & BUILDING ACENCY 20 Civic Center Plaza P.O. 8ox I988 . Santa Ana, California 92702 www.santa-ana.orglpba NOTICE TO PROPERTY OWNER Dear Property Owner: An application lor a building permit has been submitted in your name listing yourself as the builder of the property rmp rovements s pecified at e.r3 fr WeareproVidingyoUWithantomakeyoUawareof 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 ol 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 ol the permitting authority. OWNER'S ACKNOWL D MENT AND VERIFI ATI N F INF RMAT N ECTIONS: Bead 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" bu ng permit 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 linancial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. lrily homeownels insurance may not provide coverage for se injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to rkers on my property. 2. I understand buildin g permits are not required to be signed by property owners unless they are responsible for e construction 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 mysell from potential linancial risk by hiring a licensed Contractor and having the permit filed in his or her name ead of my own. 4. I understand Contractors are re quired by law to be Iicensed and bonded in California and to list their license n permits and contracts understand if I employ or otherwise engage any persons, other than Calilornia licensed Contractors, and the of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an understand if I am considered an "employer" 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 ol each "employee." I also understand my lailure to ablde by these laws may subjecl me to setious financial risk.\\ --\U-, ' understand under California Contractors' State License Law, an Owner-Builder who builds single{amily residential structures cannot legally build them with the intent to offer them for sale, unless a//work is performed by SANTA ANA CITY COUNCIL mpulido@sarta-ana.oro Mayor Pro Tem, Ward 2 m man nez@sanla.a.a.oro Vicenre Sarmienlo vsamlenlo@sanla'ana oro ltglEic@sllra:3laqg P. David Benavides Clelevides@3da: a.!a i!i!!9is@ada:a!@ sr naiero@sarla ana.oro under state and federal law. ll lic{nsed subcontractors and the number of slructures does not exceed four within any calendar years, or all ol the work is pedfermed under contract with a licensed general building Contraclor.' t,1, V',e. t understand as an Owner-Builder if lsell the property ror which this permit is issued, I may be held liable lor any fi ncial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the rkmanship or materials 9. I understand I may obtain more inlormation regarding my obligations as an "employer" from the lnternal Revenue S ce, the United States Small Business Administration, the California Department ol Benefit Payments, and the Calilornia Division ot lndustrial Accidents. I also understand I may contact the California Contraclors' State License Board (c LB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more intormation about licensed contractors 10. I am aware of and consent to an Owner-Builder building permit applied lor in my name, and undersland that I am rty legally and f inanciall yr onsible {or proposed constructio n activi ty at the f ollowing 4a"C4 11. I agree that, as the party legally and financially responsible for this proposed constructlon activity, I will abide by a plicable 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 tn rmation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public- ll you contract with someone who does not have a license, the Contractors' State License Board may be unable to asslst 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 Ior verilying whether or not thoss Contraclors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this torm must be completed and signed by the property owner and returned to the agency responsible tor issuing the permit, ,Vote.'A coDv of the DroDertv wncr's drivcr's liaense- lorm notarization or other n a uired to be ted when the Signature of Property Print name of Owner Owner ctt LLQat", iv b ,, L ->" 11 \^ ) o Al C-l< h- AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding lhe Notice to Property Owner, the execution of which lunderstand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply lor, sign, and file the documents necessary to obtain an Owner-Builder Permit lor my Scope ol Construction Project (or Description of Work)?t-\it9 6.0 ? LA$! Project Location or Address - /oo8 p. +l q - 7.r ?- Zoc) B ldeclare under penalty of perjury that I am the prope owner for the address listed above and I personally filled out the above inlormation and certily its accuracy Date: \,- )-o tclb w Note: A copy of the owner's driver's license, lorm notarization, or other veritica tion acceptable to the agency is required to be presented when the permit is issued to verily the property owner's signature. r,l.r 9/P5r alc|.k A.r,rltrL.srrblrli sf.lor.€,r.Pr.pe,irF. r.l,:1,1iiia SANTA ANA CITY COUNCIL moulido@santa-ana oro lMayor Pro Tern. Ward 2 m martrnez@santa a.a oro Vrcenle Sarmienlo vsarmlento@santa'ana.oro dbenavrdes@santa ana oro vlleoas@santa ana oro srinaiero@sanra-ana oro issued to verifv the Dropertv owner's sionature. ,-l I Name ol Authorized Aoenl: -tfirv P y @Nr€cA- Address ol Authoriz ea egent: 3/r h/ 41-++ < r t ,4,.J7-a A-J * c 11' q1 +o I Phone Number ol Authorized Agent: (Property Owneas Signature: Print Name of Owner: isolorio@sanra-ana.oro