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Home My WebLink About1247 E Fourteenth St - Misc. Permit3a t fiorut MAYOR llliguelA. Pulido I,{AYOR PRO TEM l\,4ichele Martinez COUNCILME[,4BERS P. Oavid Benavides Vicente Sarmienlo Jose Solorio SalTinajero Juan Vallegas CITY OF SANTA ANA PLANNING & BUILDING ACENCY 20 Civic Center Plaza P,O, Box 1988 . Santa Ana, California 92702 www,santa-ana,or9 / pba NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted ln your name listing yourself as the builder of the property improvements specified ut t ) 41 \Z\S+ SO A Qrro ( We are providing you with an OwnerBuilder 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 not issue a building permit until you have read, initialed your understanding ol each provision, signed, and returned this lorm to us at our olficial address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNEB'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand ot verity this information, 8q 1. I understand a frequent practice o, unlicensed persons is to have the property owner obtain an "OwnerBuilder" building permit that erroneously implies that the propeny owner is providing his or her own labor and material personally. l, as an Owner-Builder, may be held liable and subject to serious linancial 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. 0..2. 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 3. I understand as an "Owner-Buildei' 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 hls or her name instead ol my own. b1t o. ,understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. bLs. I understand if I employ or otherwise engage any persons, other than Calilornia licensed Contractors, and the total value of my construction is at least live hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and lederal law. BA-U. , understand if I am considered an "employei' under state and Federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute lo unemployment compensation of each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. l\',\ 7. I understand under Calilornia Contraclors' 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 SANTA ANA CITY COUNCIL CITY MANAGER RaulGodinez ll CITY ATTORNEY Sonia Fl. Carvalho CLERK OF THE COUNCIL lvlaria D. Huizar mouldo@santa ana.oro [,!ayor Pro Tem, Ward 2 m merl nez@santa ana oro vicente Sarmienro vsarmlenlo@sanla ana.oro P Oavid B6navrd6s dbenavrdes@sanra'ana oro ivrlleoas@sanla'ana o.o stinaiero(osanta'ana oro , isolorio@sanra.e.a oro licensed subcontractors and the number of structures does not excee.lJour \iithin any calendar years, or all of the work is performed under contract with a licensed general building Contractor. t /1 /\5u\ a. t understand as an Owner-Builder i{ I sell the property tor which tniJpermil is issued, I may be held liable tor any fin'ancial or personal injuries sustained by any subsequent owne(s) that resuli from any latent consiruction delects in the workmanship or materials. 9. I understand I may obtain more information regarding my obligations as an "employer" f rom the lnternal Revenue ervrce.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.oov for more inf ormation about licensed contractors. AA ,l0. I am aware of and consent to an Owner-Builder building permit applied lor in my name, and understand that I am the party legall address: and n anc ially re n le for OS nst ction ctlvl att e low o AQ r f. I agree that. as the party legally and financially responsible for this proposed construction activity, I will abide by alT applicable laws and requirements that govern Owner-Builders as well as employers. (.:t\tz. t 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 ol 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 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 lor 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 lo the agency responsible lor issuing the permit. A/ote: A copv ot the propertv owner's driver's license, uired to be ted when the issued to ven the owner's Signature of Property Owner Date 5\1\\4 Print name of Owner 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 documenls necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description ol Work) Proieci Locat on or Address Narne oi Authorized Agent Address 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. Property Owner's Signature Date Print Name of Owner Note: A copy of the owner's d ver's license, form notarization, ot other verification acceptable to the agency is required to be presented when the permit is issued to verify the properly owner's signature., ': SANTA ANA C TY COUNCIL mo! do@santa ana oro Mayor Pro Tem. Ward 2 mrmartine2{asanta ana.oro V cenle Sarm ento vsarm ento@santa-ana.oro solor o(asanla ana.oro P. Davd Benav des !be!av.de!@ra!G:a N lreoas@sanla afa oro stira ero@sanla.ana.oro Phone Number ol Authonzed Agenl: