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Home My WebLink About1054 W Santa Ana Blvd - Misc. PermitMAYOR ' MigudA. Pulido MAYOR PRO TET,l Michele Martinez COUNCILI\,1EMBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY OF SANTA ANA PLANNING & BUILDING ACENCY 20 Civic Center Plaza P.o. Box I 988 . Santa Ana, California 92702 www.santa-ana.org /pba NOTICE TO PROPERTY OWNER Dear Prope y Owner: An apptication for a building permit has been submitted in your name listing yourself as the builder of the property improvements specifieloSq k] . dat!.c.Afcl ts,rv b(,.2J We are providing you with an Owner-Builder Acknowledqment and lnformation Verification Form to make you aware of your responsibiliiies 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 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 KNOWLEDGMENT AN D VERIFICATION OF INFORMATON DTRECTTONS: Read and initial each statement below to signify you understand or verify this information. ')'1 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Buitdel Siihing 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 for 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 willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. ) 6! , 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. 1-{ a. f understand as an "Owner-Builder" lam the responsible party of record onthe Permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. I O , undersland Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 9V( s f understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total 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. l_(-U. , understand if I am considered an "employea' 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. 9t \ z. f understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by / r,f TWotz/ uJ ctrY |\,4ANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar SANTA ANA CITY COUNCIL moulidoaasanla-ana.oro Mayor Pro Iem. Wad 2 mimarrrnez@sBnla-ana.oro Vi.ente Sarmienro vsam enlo@sanla-a.a.oro isorono@sanla-ana oro P. Davd Benavldes dbenavides@sania-ana.oro lvilleoaslAsanla-a.a oro sl naierorOsania-3na oro 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. I -n l. a t understand as an Owner-Builder af 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 owne(s) that resuli from any latenI construction defects in the workmanship or materials. >vt 9. I understand I may obtain more information regarding 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 (27s2)or www.cslb.ca.oov for more information about licensed contractors 5H IO. I am aware of and consent to an Owner-Builder building perm it applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: )1 11. 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. *\ e. 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 also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is iniured 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. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the perm it. Nofe.' A coDv of the oroDedv own er's driver's license, form notarization.or other verification acceptable to the aoencv is reouired to be ted when the permit is issued to verifv the owner's siqnature..t ,rorof 4 lvtwb'' oat", l?-15'b/tyu.l (( Signature of Property Owner Print name of owner ?kvvN l1n Ptr:Nt,tp 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 the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work)F\ Proj ect Location or Address: lO54 Vrl. Sz r^l-6twal . Name of Authorized Agent: Address of Authorized Age t(a ( nt: I 6L C<-r,^*'/IL UI lz 2.1 Do LA. 1A cao$? Phone Number of Authorized Agent 3Lj-? b6- S L,.tt'?- I declare under penalty of perjury that I am the prop erty owner for t D address listed abpve a It-r+. (+ ^''-ft't Yet^l-nd I personally lllled out the above information and certify its accuracy h't7-r9Property Owner's Signature Date Print Name of Owner: 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 verify the propedy owner's signature. SANTA ANA CITY COUNCIL moulido@santa ana.o.o Mayor Pro Tem, Ward 2 mimarlinez@santa ana.oro VrcenteSamiento vsam ento@santa-ana.oro solorloOsanla-ana.oro P Oavd Benavrdes dbenavrdes@santa-ana oro vll eoas@santa-ana.oro sl naiero@sanla-ana.oro ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or val of that document. State of California County of Aaru,h-/ubefore me,,\ (insert name and title of the officer) personally appeared who proved to me on the bas satisfactory evidence to be the person(s) whose narne(s) is/are subscribed to the within instru ment and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand official seal Coil{ul0 r'llaatr6 tlolny ?utllt 'CilIornh LorAn$r Signature (Seal) I O^ ,4 I I I