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Home My WebLink About1515 W Eleventh St - Misc. Permit9r,/oszq MAYOR MiguelA. Pulido MAYOR PRO TEIV Michele t\,4arline2 COUNCILI\,,IEIVBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY IVANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Catualho CLERK OF THE COUNCIL lvlaria D. Huizar CITY OF SANTA ANA PLANNINC & BUILDING ACENCY 20 Civic Center Plaza P.O. Box I988 . Santa Ana, California 92702 www,santa-ana.org / pba NOTICE TO PROPERTY OWNER Dear Property Owner An application Ior a building permit has been submitted in your name listing yourself as the builder of the property imorovements soecif ied at -: ,/S/ S' i4 €z-€vA1, rm ,jr We are providing you with an Owner-Builder Acknowledoment and lnformation Verification Form to make you aware of 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 of each provision, signed, and returned this form to us at our oflicial address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. WNER'KN WLE MENT AND VERIFI ATI N F INF RMAT N TIONS: Bead and initial each statement below to signify you understand or verity this information. ul ldln 1. I understand a frequent practlce of unlicensed persons is to have the property owner obtain an "Owner-Buildea' g 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. lvly 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. 2. I understand building 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 rotect mysell from potential financial risk by hiring a licensed Contractor and having the permit filed in hls or her name instead of m y own 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license mbers on permits and contracts 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the al value ol my construction is at least live hundred dollars ($500), including labor and materials, I may be considered an mployer" under state and federal law, 6. I understand if I am considered an "employer" under state and Federal law, I must register with the state and ral government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation of each "employee." I also understand my failure 1o abide by these laws may subject me 10 SANTA ANA CITY COUNCIL moulido@sa.la-ana.oro Mayor Pro Tem, Ward 2 Er-Eadlez@lafla:@ Vrcent€ Sa.miento vsam enlo@santa-ana.oro i$lqi!@sada:!!i P. Oav d Benavides dbenavides@sanla-ana.oro jviLlggaE@sada.a!@ stinaiero@sanla ana.oro IsRrious financial risk, A-L-, I understand under California Contractors' State License Law, an Owner-Builder who builds single{amily "(/dbiOentiat structures cannot legally build them with the intent to ofler them {or sale, unless a//work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is rmed under contract with a licensed general building Cortractor 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any ancial or personal injuries sustained by any subsequent owne(s) that result lrom any latent construclion detects in the manship or materials 9. I understand I may obtain more lnformation regarding my obligations as an "employef'from the lnternal Revenue rvice, the United States Small Business Administration, the California Department ol Benefit Payments, and the lilornia Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at '1-800-32'1-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors '10. I am aware of and consenl to an Owner-Builder building permit applied tor in my name, and understand that I am the party address: legally a nd financially responsible lor proposed construction activity at the followingt/S tat €._e ve 4tt' J.r , _1 1. I agree that, as the party legally and financially responsible for this proposed construclion activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. _12. I agree to notify the issuer of this Iorm immediately ol any additions, deletions, or changes to any of the inlormation I have provided on this lorm. Licensed conlraclors are regulated by laws designed to protecl the public. lf you contract with someone who does not have a license, lhe Conlractors' State License Board may be unable to assist you with any linancial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. lt is also impo(anl for you to understand that if an unlicensed Contractor or employee of that individual or lirm is injured while working on your property, you may be held liable for damages. ll you obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible Ior 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, th lorm must be completed and signed by the property owner and ng the permit. Note: A copv of the Dropertv owner's driver's license.returned to the agency responsible f form notarizati or other verif ica table to the ,s uired to be to o nature. Signature of Property Date:.f.Ja rf Print name of Owner tu)O F*tucldaz AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice lo Properly 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 tor, sign, and iile the documents necessary to obtain an Owner Builder Permit for my project. Scope of Construction Project (or Description of Work) Proiect Location or Address 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 filled out the above information and certify its accuracy. Dale Print Name of Owner Note: A copy ol the owner's driver's license,lorm notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the prcpefty owner's signature.).fLr\,ir:lr,r:.rr,:r:A.-!tfr.i,;.:r;,ir::jr.r,.it:ri.r,.t!ir::[,::1,,:]i SANTA ANA CITY COUNCIL mouldo@sanla ana.oro [,] chele [ra.linez Mayor Pro Tem, ward 2 mlmarl nez@sanla.ana.oro Vicenle Sa.mrenro vsarmienlo@santa-ana.or.isoloro@sanla.ana.oro dbenavrdes@sarta.anaoro prlleoas@sanleana.oro slrraiero@sanla-anaoro Name ol Authorized Agent: _ Property Owner's Signature: