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Home My WebLink About2130 S Forest Ave - Misc. PermitN,4AYOR Miguel A. Pulido MAYOR PHO TEt\,l Nrichele Marlinez COU NCILI,4E[,4BERS P. David Benavides Vicente Sarmienlo Jose Solorio Sal Tinajero Juan Vi legas CITY I'ANAGEB Rau Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar CITY OF SANTA ANA PLANNINC & BUILDINC ACENCY 20 Civic Center Plaza P.O. Box 1988 . Santa Ana, California 92702 www.santa-ana.or9/pba NOTICE TO PROPERTY OWNER Dear Property Owner An application for a building permit has been submitted in your name listing yourself as the builder o{ the property improvements specified at 'L\Lb b (ov+X N.',e S*!,.. 4"", LA 1Z+ol We are providing you with an Owner-Builder Acknowledoment and lnformation Verification Form to make you aware of 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 of each provision, signed, and returned this lorm 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 ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signity you understand or verity this information.t, \ \\Jf . f understand a frequent practice ot unlicensed persons is to have the property owner obtain an "Owner-Builder" o!trdfng 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 financial risk lor 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 lor those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on m y property 2. I understand building permits are not required to be signed by property owners unless they are responsible lor construction and are not hiring a licensed Contractor to assume this responsibility 3. I understand as an "Owner-Builder" I am the responsible party ol record on the permit. I understand that I may ect myself f rom potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own I understand Contractors are requlred by law to be licensed and bonded in California and to list their license numbers on permits and contracts. {- r-\ 2AJ-S. I understand if lemploy or otherwise engage any persons, other than California licensed Contractors, and the \.ldtal value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an ''employer" under state and federal law. 6. I understand if I am considered an "employea' under state and Federal law, I must register with the state and eral 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. 7. I understand under California Contractors' State License Law, an Owner-Builder who builds singlejamily idential structures cannot legally build them with the intent to olfer them for sale, unless a// work is performed by SANTA ANA CITY COUNCIL mool do@sanla.ana.oro Mayo. Pro Tom, Ward 2 mrmanrfl ez@santa-ana.oro vicente sarmienlo vsarmienlo@sanla-ana.oro isolo.io@sanla.ana.oro P Davd Benavdes dbemvides@sanla-ana.oro iv lleoas@santa ana.oro sllnaiero@sanla-ana.oro 10)tao9 / ti licensed subcontractors and the number of structures does not'exceeci four within any calendar years, or all of the work is pe rf rmed under contract with a licensed general building Contractor 8. I understand as an Owner-Builder lf I sell the property for which this permit is issued, I may be held liable {or any ncial or personal injuries sustained by any subsequenl owner(s) that result from any latent construction defects in the workmanshi p or materials 9. lunderstand lma y obtain more information regarding my obligations as an "employef'from the lnternal Revenue ice, t he United States Small Business Administration, the California Department ol Benefit Payments, and the a lifornia Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board C LB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors th pa 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 responsible for proposed construction activity at the following dd ESS 11. I agree that, as the party legally and linancially responsible for this proposed construction activity, I will abide by 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 rmation Licensed contractors are regulated by laws 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. torm notariza wn Signature of Property Owner Date Scope ol Construction Project (or Description of Work) Project Location or Address +h't<-.*a.-6a\ Name ol Aulhorized Agent Address of Authorized Agent 5.Fla \a 1zlocl Phone Number of Authorized Agent q I declare under penalty of perjury information and ce(ify its accurac atlamth rope ner for the address listed above and I personally lled out the above Property Owner's Signature Date e \o Print Name oi Owner: Note: A copy ol the owner's driver's license, torm no tion,oro verification acceptable to the agency is required to be presented when the permit is issued to verity the property owner's signature. SANTA ANA CITY COUNC]L moulido@sanla-ana or. lMayor Pro Tem. Ward 2 m ma'1rner@santa.ana.oro v cenle sarmienro vsarmrenlo@sanla.ana.oro i$Ls!r.a@sa@:e!a ivilleoas@santa a.a.oro sr naie.o@sanla.ara.oro I have provided on this Iorm. Before a building permit can be issued, this lorm musl be completed and signed by the property owner and returned to the agency responsible lor issuing the permit. Nofej A copv ot the prcpertv owner's driver's license. Print name of Owner AUTHORIZATION OF AGENT TO ACT ON PBOPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the ,ollowing person(s) to act as my agenl(s) to apply tor, sign, and iile the documents necessary to obtain an Owner Builder Permil for my project. I Jz+o1 I P. Dav'd Benavrdes dbenavides@sarta-ana oro