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Home My WebLink About127 W Secrest Way - Misc. PermitMAYOR N/iguel A. Pulido MAYOR PRO TET,l N4ichele Martinez COUNCILMEMBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY IVIANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL lvlaria D. Huizar CITY OF SANTA ANA PLANNINC & BUILDING ACENCY 20 Civic Center Plaza P.O. Box I988 . Santa Ana, California 92702 www.santa-ana.orglpba 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 improvempqts specif ie4at('-Craz c fIl ae, A \[aLxPz utAlA We are providing you with an your responsibilities and poss rBuilder Acknowl ln ation Verification Fo 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 execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDG MENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand or verify t his information. fu ', , 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 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. -N r runderstand building permits are not required to be signed by property owners unless theyare responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. Il/ 3. I understand 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 filed in his or her name instead of my own. -N O , understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. N U. tunderstand 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 federal law. U/ A. I understand if I am considered an "employer" under state and Federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' com pensation 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. N ,. lunderstand under California Contractors' 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 mou do@santa ana.oro vsarmienlo@sanla-a.a oro l!9L9ri9@!g!1e9!as9 dbenavrdes@sanla-ana oro ivilleoasrAsanla-ana oro srinaiero@santa-ana oro SANTA ANA CITY COUNCIL Mayor Pro Tem, Ward 2 mrman nez@sanla-ana.oro licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is performed under contract with a licensed general building Contraclor. -0d-U , understand as an Owner-Builder if 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 defects in the workmanship or materials. riW g. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Service, 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 information about licensed contractors. A^)10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party leg address: all and financially sible for prop osed construction activi at the following w '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. rtttVv 12.1agree to notify the issuer of this form immediately of any additions, deletions, or changes lo 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 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' com pensation 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 permit. /Votej s driver's license form notarization or other a table to the IS uired to be issued e ature. Signature of Property Owner Date:z Print name of Owner 0 qVL A lew zqE [ fr 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 tor, sign, and file 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 Address 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 certify its accuracy. Date: mou do@sanla ana oro Mrchele Marlioez Mayot Prc 1en, V'! ad 2 mimadrne2@santa ana.oro vsarnne.to@sanra-anaoro soono@sanla-anaoro P Drvid Benavides dbenavides@santa ana.oro iv &6s@sanla-ana oro slr.aiero@sa.ta-a.a oro Property Owners Signature: _ Print Name of Owner: _ Note: A copy of the o*ner's arirer te to the agency is required to be presented when the permit is issued to verify lhe property owner's signature. Pl .rilPaiai.i.iriir,,,:r.r.:,.r,.j-ilr'r,l]..r.Pr',i,rirIrria:-,::1ar SANTA ANA CITY COUNCIL