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Home My WebLink About1006 & 1008 N Broadway - Misc. PermitIVAYOR Migue A. Pu ido IVAYOR PRO TEI.4 l\.4iche e Martinez COUNCILMEMBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY OF SANTA ANA PLANNING & BUILDING AGENCY 20 Civic Center Plaza P.O. Box 1988 . Santa Ana, California 92702 www.5anta-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 o, the property m rovements s fied at fk ('A- 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 not issue a building permit until you have read, initialed your understanding ol 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 ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below lo signify you understand or verity this information. ,,t/1 l. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" building 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 lor any injuries sustained by an unlicensed person and his or her employees while working on my property. Ir,4y homeowner's insurance may not provide coverage lor those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage lor injuries to workers on my property. ,lJL Z. t 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. dL S. lunderstand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit liled in his or her name instead of my own. u/L 4. I understand Contractors are required by lawto be licensed and bonded in California and to listtheir license nurnbers on permits and contracts. u// 5 I undersland if I employ or othsrwise engage any persons, other than California licensed Contractors, and the tot-al value of my construction is at least live hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. tu( 6. I understand if I am considered an "employer" under state and Federal law, I must register with the state and lederal 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. l,rJL z . t understand under California Conlractors' State License Law, an Owner-Builder who builds single{amily 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 BaulGodinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar moulido@santa-ana.oro Mayor Pro Tem. Ward 2 mimanine2@santa ana.oro V cenle Sarmrenlo vsamienlo@sanra.ana.oro isdsi!@laqa:!!a!4 P. Davd Bâ‚¬navides dbenavides@sanra-ana.oro ivrlleoas@sa.ra ana.oro sr naiero@sanla ana.oro licensed subcontractors and the number of structures dobs not exceed lour within any calendar years, or all ol the work is performed under contract with a licensed general building Cdntractor. - u/L-A. I undersland as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable f or any Iinancial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or materials. V 9 I understand I may obtain more information regarding my obligations as an "employea'Irom the lnternal Revenue Sbrvice, the United States Small Business Administration, the California Departmenl ol Benelit Payments, and the California Division of lndustrial Accidents. I also understand I may contact the Calilornia Contractors' Stale License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. wL 10.1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am lhe party legally and financially responsible for proposed construction activity at the following address: /oog * ro& ). Beo*o".tA^l e**r*1A- q"?-bt uuL ll.l 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 Owner-Builders as well as employers. 'rJL e.l agree to notify the issuer of this form immediately of any additions, deletions, or changes to any ol the information I have provided on this lorm. Licensed contractors are regulated by laws designed to protect the public. lf you contract with someone who does not have a license, lhe 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 il an unlicensed Contractor or employee ol that individual or firm is injured while working on your property, you may be held liable lor damages. ll you obtain a permit as OwnerBuilder and wish to hire Contactors, you will be responsible for verilying whether or not lhose Contractors are properly licensed and the status ol their workers' compensation insurance coverage. Berore a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible tor issuing the per mit. /Vote; A coDv ot the DroDertv owner's driver's license, form notarization. or other veritication acceDtable to aeency is required to be presented when the permit is issued to Signature of Property Owner Date:Zz> / Print name of owner dorl O L AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I undersland is my personal responsibility, I hereby authorize lhe following person(s) to act as my agent(s) to appiy for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description ol Work)$ae ?a*vs-<s Prolect Location or Address /ooq + /@C P. bza*,*rtf ?{4J9â‚¬-cA- Address of Authorized Agent Zt( tJ, Cl't+ ri 9Mt-+ *rJ+ C* nZlor Phone Number ol Authorized Agent 7/( 647-oool- ldeclare under penalty of perjury that I am the property er for the address listed above and I personally fjlled out the above information and certify its accur Property Owner's Signature Dale: 5 lc,/5 Print Name of Owner: t .tot'l ( **y'c), Lll Note: A copy of the neriticat'ron accepAOte to the agency is required to be presented when the permit is issued to verify the property owner's signature. SANTA ANA CITY COUNCIL moulido@santa'ana oro Mayor Pro Tem, Ward 2 m man nez@sanla-ana oro V ce.re Sam ento vsarm ento@santa-ana.o.o isgbio@lrda:a!tuI P. Oavrd Benavrdes dbenav des@sanra'ana.oro illlelr!@ttolftet3.ca slinai6ro@sanla ana.oro Name of Authorized Agent: