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Home My WebLink About126 E Dyer Rd Unit# A - Misc. PermitMAYOR Miguel A. Pulido MAYOR PRO TEM Claudia C. Alvarez COUNCIL MEMBERS P. David Eenavides Carlos Bustamante Michele Martinez Vincent F. Sarmiento Sal Tinajero Dear Property Owner: An application for a building permit has bee improvements specified "t \?-& t--_ . q CITY OF SANTA ANA PLANNINC & BUILDING AGENCY 20 Civic Center Plaza P.O. Box I 988 . Santa Ana, California 92t|z www.5anta-ana.org NOTICE TO PROPERTY OWNER n submitted in your name listing yourself as the builder of the property *.<.- @*o-A !rri\ e Al Sc,...\.- $rrc" ,Q15 lzlol We are providing you with an your responsibrlities and poss uilder kn ent and I rificati nF 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 of each provision, signed, and returned this form to us at our official address indicated. An agent of the owner cannot exeiute this notice unlesJ you, the property owner, obtain the prior approval of the permitting authority. R'S ACKNO T AND VERIF ON OF INF TON DIR NS: Read and initial each statement below to signify you understand or verify this information. 1. I understa nd a frequent practice of unlicensed persons is to have the property owner obtain an "owner-Builder,, bu il ng permit that erroneously implies that the property owner is providing his or her own labor and material personally. l, as an Owner-Builde r, may be held liable and subject to serious financial risk for any injuries sustained b y an unlicensed person and his or her employees while working on my property My homeowner's insurance may not provide coverage for those inj ries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to bn my property I understand building permits are not required to be signed by prope rty owners unless they are responsible for nstruction and are not hiri ng a licensed Contractor to assume this res po ns ibilitye /,/ bro(C4t m lundersta nd as an "owner-Builder" I am the responsible party of record on the permit. I understand that I m ay yself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her nam e instead my own nu alue I understand Contractors are required by law to be licensed and bonded in California and to list their license on permits and contracts. understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an under state and federal law. CITY MANACER Paul M. Walters CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar "employer" /:--6 I understand if I am considered an "employer" under state and Federal law, I must register with the state andfeder/l government, withhold payroll taxes, provide workers' compensation disability insurancel and contribute to unemployment compensation of each "employee." I also understand my failure to rbide by these laws may subject me to serious fi4ancial risk. ,,4. I. l.understand under California Contractors' State License Law, an Owner-Builder who builds singlejamilyr6idâ‚¬nlial structures cannot legally build them with the intent to offer them for sale, unless a// work is periormeo by licedrsed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work isperformed under contract with a licensed general building Contractor. 1/-8 I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any fihalcial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workma ip or materials. nderstand I may obtain more information regarding iry oOtiiations as an "employef' from the lnternal Revenue., lu e the United States Small Business Administration, the California Department of Benefit Payments, and the Cal ia 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.qov for more information about licensed contractors r,..,10 tFre party I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am legally and finan ciallv L.1) responsible for propos ed truction activ at the,lc,)followingcons 5uaddress:C 0r- la I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the on 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 wath 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 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 for 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 to the agency responsible for issuing the pel it. ,Vore.' A coov of the Drooertv wner's driver's license. form n other a ,s d when the issued to the Drooeftv own sianature. . I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by able laws and requirements that govern Owner-Builders as well as employers. ,14 Signature of Property Print name of Owner Owner Date lL-s'tJ u l,r-rG"r+\ AUTHORIZATION OF AGENT TO ACT ON PROPERW 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, sjgn, and file the documenls necessary to obtain an Owner-Builder Permit for my project. ScopeofconSlrUctionProjecl(orDescriptionofWork): Project Location or Address: Name of Address Aiithorized Aoenti of Authorized Age nt: 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 lilled out the above information and certify its accuracy. Property Owner's Signature Print Name of Owner: Date Note: \A copy of the owner's driver's license, form notarization, or other verification accepaable to the agency is required to be preqented when ahe permit is issued to vctify the propefty owner's signature. PLink:WP51/Counter Activity/Assembly Bills/Notice to Property Owner & Authorization Fotm 06-2012