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Home My WebLink About1209 E Park Ln - Misc. PermitMAYOR MiguelA. Pulido MAYOR PRO TEI\,4 Michele Martinez COUNCIL[,4EIUBERS P. Oavid Benavides Vicente Sarmiento Jose Solorio Sal Tinajero Juan Villegas CITY MANAGEB Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL lvlaria D. Huizar CITY OF SANTA ANA PLANNINC & BUILDING AGENCY 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 in your name listing yourself as the builder of the property improvementsspecified"t l)cg g,p"rL L^ so^l . an,., 6s, c0')o5 moU do@sanla.ana.oro Mayor Pro Tem, Ward 2 mrmanroez@sanla.ana.o.o isolono@sanla.ana.or. P Oavid Bâ‚¬.avides dbenavides@santa.ana.oro ivilleoas@sanla'ana.oro 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 ln 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. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you underctand verity this information. Jl]<-1. I understand a f requent 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 for any injuries sustained by an unlicensed person and his or her employees while working on my property. lVly homeownels 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. -XJ4 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. d(d' ,. I understand as an "Owner-Buildei' I am the responsible party ol 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. J\().l<' 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license nurnbers on permits and contracts. f,'4L t. 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. -/1Jl^tt 6. I understand if I am considered an "employer" under state and Federal law, I must register with the state and federal gorernment, 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 Iinancial risk. VJ/" z. I understand under California Contraclors' State License Law, an OwnerBuilder who builds single-lamily residential structures cannot legally build them with the intent to oller them for sale, unless a//work is performed by SANTA ANA CITY COUNCIL vsarm ento@sanla.ana.o.o sl naiero@santa'ara.oro licensed subcontractors and the number of structures doe's not "r"""a four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. 5-li A. t understand as an OwnerBuilder rf I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defecls in the workmanship or materials. $ 4 t. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Bevenue 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 Calilornia Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more inlormation about licensed contractors. /,1a!!!lO I am aware of and consen't to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and flnancially r6spopsible for groposedponstrucJion activ addiess: - l.\Oq < flci I/ tr.o S,:,,r,\s 4a"., (*' ct)!.{h" totto*ins e4 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. JIAI2. I agree to notify the issuer of this lorm immediately ol 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 for you to understand that il 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 for verilying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permil can be issued, this lorm must be completed and signed by the property owner and returned to the agency responsible lor issuing the permit. Note; A copv of the DroDertv owner's driver's license. form notarization, or othet veritication acceptable to the agency is required to be presented when the permit is issued the wner s nature, 5.30',Joi'lSignature of Property Print name of Owner 5 Owner Date: e 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 aulhorize the following person(s) lo 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 ol Work) Project Location or Address Name of Authorized Agent Address of Authorized Agent Phone Number of Authorized Agent ldeclare under penalty of perjury lhat 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 Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to le presen.ted ,wh:n the leyit is i?sued to verify the property owner's signature. SANTA ANA CIIY COUNCIL mpuldo@santa-ana.oro [rayor Pro Tem, Ward 2 mlmanrne2@sanra ana.oro vsamento@santa ana.oro solono@sa.la ana oro P Davd Benavdes dbenavrdes@sanla.ana.oro ivilleoas@sanra.a.a on slBier9@t344:a!a.qq ?"'Y Print Name of Owner: