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Home My WebLink About1708 S Center St - Misc. Permit/ 0 1224qr' MAYOR N,4iguelA. Pulido MAYOR PRO TEM Michele Martinez COUNCILMEI\,1BERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY MANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar CITY OF SANTA ANA PLANNINC & BUILDING AGENCY 20 Civic Center Plaza P.O. Box I 988 . Santa Ana, Califo.naa 92702 www.santa-ana.org / 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 of the property rmorovemlloz ents specified.at.- C"^Ir.<I 1..^1" An, (A 1n ca We are providing you with an Owner-Builder Acknowledqment and lnformation Verification Form to make you aware of your responsibil[ies 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 form to us at our officiil 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 AC KNOWLEDGMENT AND VERIFICATI ON OF INFORMAT ON ,M 0l. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" 6tffig permit that erroneously implies that the property owner is providing his or her own labor and material personally. l, as an 5wner-Builder, may be neld iiaOte and subject to serious financial risk for any inluries 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 willfuily;cting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. /Vl 0 Z. I understand building permits are not required to be signed by property owners unless they are responsible for tfre construction and are not hiring a licensed Contractor to assume this responsibility tul /) 3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may ffiiat mysetf from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. M n +. I understand Contractors are required by law to be licensed and bonded in California and to Iist their license numbers on permits and contracts. l/ 6 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the 6|.-"t *tr" of my construction is at least five hundied dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. ,M_o_A. I understand if I am considered an "employer" under state and Federal law, I must register with the state and 6d6El government, withhold payroll taxes, provide workers' com pensation disability insurance, and contribute to unempl6yment compensation of each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. AA A 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family EtiE-ential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. SANTA ANA CITY COUNCIL mou do@saita aoa.oro l,layor Pro Tem Ward 2 m man nez@sa.la-ana.oro vrcenle Sam enio vsarmienlo@sanla-ana.oro solor orOsa.la-ana oro P Drvld B€nevdos dbenavides@sania-ana.oro iv1l 9!?s@!?!1?:4!34!s rr .a .aroasanla-ana o.o Mo 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the p arty legally and financiall y respo nsI ible for prop osed construction activ ity at the following address: l-Jn 3 1 c.^l s )" A.. cA ?>'7 M O 1,. 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-Bullders as well as employers. WZ.I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. 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 aiso 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 Contaclors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be compl returned to the agency responsible for issuing the permit. Nofe.. eted and signed by the property owner and form notarization, or other verification able to the aoencv is ired to be Dresented w the permit is issued ao verifu the Dropertv own er's siqnature. Date: q )Signature of Property Owner I tq Print name of Owner 40" o n al(') r da L 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 thefollowing person(s) to act as my agent(s) to apply for, sign, and file the documenti necessary to obtain a; owner-Builder permit for myproject. Scope of Construction Project (or Description of Work) 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 fi ed out the aboveinformation and certify its accuracy. Property Owner's Signature Print Name of Owner: Date Note: A copy of the owne be presented when the pe r's driver's license, form notarization, or other verification acceptable to the agency is required to rmit is issued to verify the properly owner's signature- SANTA ANA CITY COUNCIL Mayor Pro Tenr Ward 2 mo!lido@santa-ana oro Vrce.te Sarm enlo vsarmienro@sanra anaord isolonorOsan16-ana.oro dbe.avldes@sanla ana ora iv eoas@sa.la ana oro siinaiero@santa-a.a.oro licensed subcontractors and the number of structures does not gxie#four within any calendar years, or all of the work isperformed under contract with a licensed general building Contractor. fiO-a I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. Uqg I understand lmayobtaln more information regardang my obligations as an "employer" from the lnternal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California 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.qov for more information about licensed contractors. A copv of the Dropertv owner's driver's license, Project Location or Address: _