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Home My WebLink About2417 W Borchard Ave - Misc. Permit2e t Ara zf MAYOR Miguol A. Pulido MAYOB PBO TEM Michele t\rartinez COUNCILMEMBERS P. David Benavides Vicente Sarmiento Jose Solorio Sal Tinajero Juan Villsgas CITY OF SANTA ANA PIANNING & BUILDING AGENCY 20 Civic Center Plaza P.O. Box I 988 . Santa Ana, Caltfornia 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 yoursell as the builder of the property rmprove ments s pec I r We are providing you with an your responsibilities and poss er Ack rm rifi to make you aware of ible 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 ot 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. ER'S ENT AND VE F INFORMA DIRECTIONS:Read and Inltlal each statement below to slgnity you understand or vertty thts lntormation. )?-l . f understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner.Buildei' building permit thal 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 uhlicenseci person and his or her employees while working on my property. lvly homeowner's insurance may not provide coverage for those injuries. I am willtully acting as an Owner-Builder and am aware o{ the limits of my insurance coverage {or injuries to workers on my property. 'Df.-2. I understand building permits are not required to be signed by property owners unless they are responsible lor the construction and are not hiring a licensed Contractor to assume this responsibility. Da-g. I understand as an "Owner-Builder" I am the responsible party ol record on the permit. I understand that I may protect myselt from potential linancial risk by hiring a licensed Contractor and having the permit liled in his or her name instead ol my own. DP-q. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. DP-5. I understand il I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least flve hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. 2P-0. f understand if I am considered an "employer" under state and Federal law, I must register with the stato and federal government, withhold payroll taxes, provide workers' compensation disabillty insurance, and contribute to unemployment compensation ol each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. D1-1. t understand under California Contractors' State Llcense Law, an Owner-Builder who builds single-lamily residential structures cannot legally build them with the intent to ofter them for sale, unless a//work is performed by SANTA ANA CITY COUNCIL m.uliddiAsnta-ane,ob Mayor Pro T6m, Ward 2 mimanin6zaA*nla-.ne.oro Vicents Sarmi€nto vs6mi6nro@santa-ah..or.isahde@$dr:9lssc P oavid B6nevide. dbenavidos@6anle-ena.o.o ivi!9qer@$d&s!r.etq Sal Tinajsro srin.i6r6@sntE-ana.ord CITY MANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar 9-"ltnrc72 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. -E-e. t 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 subsequenl owne(s) that result Irom any latent construction defects in the workmanship or materials. }f-g. I understand I may obtain more information regarding my obligations as an "employer" trom the lnlernal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division ol lndustrial Accidents. I also understand I may contact the Calitornia Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. -D,P f O. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the tollowing "dd'o"". DP t t. I agree that, as the party legally and tinancially responsible for this proposed construction activity, I wlll abide by allapplicable laws and requirements that govern Owner-Builders as well as employers. NLf Z. t agree to notify the issuer of this lorm immediately of any additions, deletions, or changes to any of the inlormation 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 lor you to understand that il an unlicensed Contraclor 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 tor verifying whether or nol those Contractors are properly licensed and the status ol their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and relurned to the agency responsible lor lssuing the permit. IVo,e.' A coov of the propertv owner's drlver's license. torm notarizatlon. or other verlficatlon acceptable to the aoencv is reouired to be presented when the pemlt is Signature of Property Print name of Owner Owner Date: 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 responsibility, I hereby authorize the following person(s) to act as my agent(s)lo apply for, sign, and lile the documents necessary to obtain an Owner-Builder Permit for my project. Scope o, Construction Project (or Description of Work) Project Location or Address Name oI Aulhorized Agent: Address ot Authorized Agent Phone Number o, Authorized Agent +5 I declare under penalty of perjury that I am the property e Jor the address listed above and I personally rilled out the above information and certily its accuracy. Date: d.< lll,tMProperty Owner's Signature: A{ -Tff- Print Name o, Owner: Note: A copy ot the owner's drlver's form no tlon, ot other verlllcatlon dcccptdble to the dgency ls requlred to be presented when the permlt ls lssued to verlfy the proryfiy owner's slgnature. Pl-ink:WP51 /Ccunl6 AclvilyrAssemblyBrlrs jNo!.G !o Property Form 03 1 n.2016 SANTA ANA CITY COUNCIL moulido@sanLr-ana.orc M chelo Maninez Mayor Prc T6m, Wad 2 mimertinez@enta-ana-or. vicont€ Sarmi€nto vsdmi6nto@s6nla-ana.oro isolorio@stnta-ana-oro P. David Benavldss db6nrvid6s@$nta-ana,ord ivillaoaBAsanta-ana..E stin6i6ro@sente-ana.oro os/ /+ltq