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Home My WebLink About319 S Birch St - Misc. PermitI\,,!AYOR Miguel A. Pulido MAYOR PRO TEM l,/ichele lr4artinez COUNCILI\,{EMBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinalero Juan Villegas Dear Property Owner /of/ oor{)-/ CITY MANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar CITY OF SANTA ANA PLANNING & BUILDINC ACENCY 20 Civic Center Plaza P.O. Box 1988 . Santa Ana, California 92702 www.santa-ana.org /pba NOTICE TO PROPERTY OWNER An application for a building permit has been submitted in your name listing yourself as !!e builder of the property improvementsspeciriedat 2 q < B;orrl ,tr. )*rt* A-l-+ We are providing you with an Owner-Builder Acknowledoment and lnformation Verification Form to make you aware ol your responsibilities and possible risk you may incur by having this permit issued in your names as the Owner-Builder. We will nol 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 ol the owner cannot execute this notice unless you, the property owner, obtain the prior approval ol the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON DIBECTIONS: Bead and initial each statement below to signify you understand or verity this information. $1. I understand a lrequent practice of unlicensed persons is to have the property owner obtain an "OwnerBuilder" uilding permit that erroneously implies that the property owner is providing his or her own labor and material personally. l, as an OwnerBuilder, 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 for those injuries. I am willlully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on mv DroDerlv. n /1.lr', z. I understand building 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. 0&'r. ,understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential linancial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of mv own.zrAla.lt'l" ' 4. I undersland Contractors are required by law to be licensed and bonded in California and to list their license numbers on permils and contracts. rt ll . PY S. t understand if I employ or olherwise 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. F lL'u. tunderstand if I am considered an "employei'under stale and Federal law, I must register with the state and federal governmenl, 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 financlal risk. .t /) [:!21. t understand under Calilornia Confactors' State License Law, an Owner-Builder who builds singlejamily residential structures cannot legally build them with lhe intent to offer them for sale, unless a//work is performed by SANTA ANA CITY COUNCIL vsarm.flo@jsafra-ana oromoulido@santa-ana.oro Michele Manrne? Mayor Pro Tem, Ward 2 m aari.ez@santa-ana.oro isoloro@sanla.ana.oro P. Davd Benavrdes dbenavrdes@sanr. ana.oro ivilleoas@sania-ana.oro slinaiero@sanla-ana.orc licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. --1l,t!-a I understand as an Owner-Builder if I sell the propbrty 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. [tr-4-tn. tunderstand I may obtain more information regarding my obligations as an "employe/ from the lnternal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the Calilornia Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed conlractors. [9 tl'lO.I am aware ot and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and fina address: lyr n slb for p constructi ctivity at the f ollowing (s{i1. I agree that, as the party legally and financially responsible lor this proposed construction activity, I will abide by all applicable laws and requirements that govern OwnerBuilders as well as employers. /l fi-( p t agree to notlly the issuer of thls 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 also lmportant for you to understand that il an unlicensed Contractor or employee of that individual or firm ls 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 veri{ying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, lhis lorm mus completed and signed by the property owner and returned to the agency responsible lor issuing the l. Note: A copv of the propertv owner's driver's license, form notarization ot other verificatio table is uired to be d when the it is issued to veri the o Signature of Property Owner Date 6 2 Print name of Owner o14 AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution ol which I understand is my personal responsibillty, I hereby authorize the lollowing person(s) to act as my agent(s) to apply Jor, sign, and lile the documents necessary to obtain an Owner-Bullder Permit for my project. Prolect Location or Address Address of Authorized Agent Phone Number of Authorized Aoent I declare under penalty of perjury that I am the property owner lor the address listed above and I personally filled out the above information and certify its accuracy. Property Owner's Signature Dale Pr nt Name of Owner Note: A copy ol the owner's driver's license,lorm notarization, or other verilication acceptable to the agency is required to be presented when the permit is issued to verify the property ownet's signaturc- SANTA ANA CITY COUNCIL nature- h.ul'do@sa.la-ana.oro Mayor P.o Tem Ward 2 m marl ne2@sa ra ana.oro V ce6te Sam enlo $a!ErE!&@safla:a!a isolor o@sanra-ana oro P Davd Beoavdes dberavides@sanra.a.a oro rr.eoas@sa-ld d " o'o "0, drc oras"ild.dr a o' Scope of Construction Projecl (o. Desc.iptron ol Wo.k): Name of Authonzed Agent:_