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Home My WebLink About1201 S Douglas St - Misc. PermitMAYOR N,4iguel A. Pu ido IVAYOR PBO TEI\,I l\,4ichele Martinez COUNCILMEMBERS P. Oavid Benavides Vicenle Sarmiento Jose Solorio Sal Tinajero Juan Villegas CITY OF SANTA ANA PLANNINC & 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 Property Owner: An application for a building permit has been subm dinyo ur name listin g yourself as the builder of the property rmp specified atrove .1- We are providing you with an Owner-Builder Acknowledoment and lnformation Verification Form to make you aware of your responsibililies and possible risk you may incur by having this permit issued in your names as the OwnerBuilder. 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 olficial address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of lhe permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFOHMATON DIBECTIONS: Read and initial each statement below to signify you understand or verity this information. Kl ( I . t understand a f requent practice ol unlicensed persons is to have the property owner obtain an "OwnerBuilder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. l, as an OwnerBuilder, 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. l\4y homeowner's insurance may not provide coverage lor those injuries. I am willfully acting as an Owner-Builder and am aware ol the limits ol my insurance coverage for injuries to workers on my property. (T lz. 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. 3. Iunderstand as an "Owner-Buildei' I am the res ponsible party of record on the permit. I understand that I may protect myself lrom potential financial risk by hiring a licensed Contractor and having the permit liled in his or her name instead of my own. -LI-L4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. tlf lS I 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 lederal law. ,p-f)Ll I A. I 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 to unemployment compensation of each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. A ll. I understand under California Contractors' State License Law, an Owner-Builder who builds singleJamily residential structures cannot legally build them with the intent to offer them for sale, unless a//work is performed by CITY N,IANAGER Raul Godinez ll C Y ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar moulido@santa.ana.oro Vlcenre Sarm enlo vsam e.lo@santa-ana.o.o 6olono@sanla ana oro P Davd Benavdes dbenavdes@sanla.ana.oro SANTA ANA CITY COUNCIL I \ Mi.hele M.dinez Mayor Pro Tern. Ward 2 mimanrne2@santa ana.oro Juan Villegas SalTinajero Ward 5 Ward 6jruega!@sada:a4a sti.ai6ro@sanla,ana.o.o licensed subcontractors and the number ol structures does not exceed four within any calendar years, or all ol the work is performed under contract with a licensed general building Contractor. 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable lor any inancial or personal injuries sustained by any subsequent owne(s) that result from any latent construction delects in the workmanship or materials 9. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Se ce, the United States Small Business Administration, the California Department ol Benelit 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. LI-LIO.l am aware ot and consenl to an Owner-Builder building permit applied for in my name, and understand that I am thb [arty legally and financially responsible for proposed construction activity at the following address: 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all app licable laws and requirements that govern Owner-Builders as well as employers inf o 2. I agree to notify the issuer of this rorm immediately of any additions, deletions, or changes to any of the ation 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 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 responslble Ior verifying whether or not those Contractors are properly licensed and the status ol their workers' compensation insurance coverage. Betore 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 permit. /Votei Aco DV of the DroDertv wncr' 1 drivcr's license- form notarization, or other veritication acceptable to aoencv is reouired to be presented when the permit is issued to verifv the property owner's signature./a' Signature of Property Owner Date Print name of Owner AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice lo 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 1or, sign, and iile the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work) Project Location or Address Name 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 certily its accuracy. Property Owner,s Signature Date:_ Print Name of Owner Note: A copy of the owner's driver's license, lorm notarlzation, or other verilication acceptable to lhe agency is required to be prcsented when the permit is issued lo verify lhe property ownet's signature. :,|i'y.ii:,a.:,irrrir.a.rrtr/i..omt!,i..;!....r.::,..,:.\a.:i:.,14:.,1 SANTA ANA CITY COUNCIL moulidordsanla ana oro Mrchele Man'nez Mayor Pro Ten. Ward 2 r!i$nl!ez@sa!la:a V cenle Sam enlo vsarm enro@sanra.ana oro E!lq!@sada:a!aq9 P Oavd Be.avides dbenavrdes@santa-ana oro ivrXeg-as@$da:ala stinaiero@sanla'ana.oro I ,,J Address ol Authorized Agent:_