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HomeMy WebLinkAbout1307 & 1307 1%2 W Ninth St - Misc. PermitPlannlng & Bulldlng Agetcy Bulldlng Safoty Division 20 Clvlc conter Plaza P.O. Box 1988 (n-19) Santa Ana, CA 92702 (714) 647-s800 www.Santa-ana.org Ra APP.13 CBC 2016 NOTICE TO PROPERW OWNER oear Property owner An application for a building rmit has been submitted in r name listing yourse It as the builder of the property ents specified at We ara providing you with an Owner-Bullder Acknowledoment and lnformation Verification For.r.n to make you aware of your r"sponsibililes ind possible rEI'!6IEEy lncur by having ttris permit lssued in your names as the Owner-Builder. We will not issue a building permit untll you have read, initialed your understanding of each provision, signed, and rctumed this form to us at our officiat ad-diess indlcatid. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the Permittlng aulhority. I understand if I employ or otherwise engage any persons, other than Califomia lic8nsed Contractors, and the total my construction is at least five hundred dollars (5500). includlng labor and materials. I may be considered an DIRECTION Road and tnlttat each statement bslow to slgnw you understand or verlfy thls lnformatlon. I undeGtand a frequent practice of unlicensed pe rsons ls to have the property owner obtain an 'Owner'Builde,' build- rmit hat enoneously implies that the property owner is providing his or her own labor and material personally. l, as an r-Builder, may be held liable and subject to serious fina ncial risk for any in u ries sustained by an unlicensed person and his or her employees while working on my property. My homeowneis insurance may not provlde coverage for those inju,ies. I am willfully acling as an Owner-Buitdor and am aware of the limits of my insurance coveftlge for injuries to workers on my prop- erty I understand building permits are not required to be signed by property owners unless they are responsible for the on are not hiring a licensed Contlador to assume this responsibility I undersEnd as an 'Owner-Buildsf I am the responsib le party of record on the permlt I understand lhat I may Protect f from ntial financial rlsk by hiring a licensed contracto r and having the permlt filed h his or her name instead of my own. . I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers rmits' of t"u state and federal law. I understjand if I am consld6red an "employer" under stats and Federal law, I must rggister with the state and federal ment, wlthhold payroll taxes, provlde workers' compensation disability insurance, and contributs to unemployment com- 'amployee." I also understand my failure to ablde by these laws may subiect me to serious financial risk. . I understand under Califomla Contractors' State Liceng6 Law, an Owner-Builder who builds single-hmily resid6ntial cannot lsgally build them with the intent to offer them for sale, lnless a,, work is performed by licensed subcontrac- tors and the number of sEuctures does not exceed four withln any calendar years. or all of the work is performed under contract with a llcensed general buildlng Contraclor. /1 4lM unOerstand as an Owner-Builder if I sell the property fo; which this permit is issued, I may bs held liable for any finan- cial'or personal injuries suslained by any subsequent owne(s) that result from any latent construction defecls in the workman- ship or materlals. OWNER'S ACKNOWLEGMENT AND VERIFICATION OF INFORMATON qg0tract5. of 9. I understand I may obtain more information regardin g my obligations as an 'employef from the lntemal Revenue Ser- , lhe United Statas Small Business Administration, the California Department of Benefit Payments, and the Califomia Oivi-sion ol lndustrlal Accid ents. I also understand I may con tact the Califom ia Contractors' State License Board (CSLB) at 1{OO-321€SL (2752) or www.cslb.ca.oov for more information about licens ed contractors. 10. I am awa re ol and consent to an Owner-Builder bullding permit applied for in my name, and understand that I am the at the following ad-legally and res for proposed conskuction dress 1. I agre e that, as. the Party.legally and tinancially responsible for this proposed construclion activity, lwill abide by all and requirements that govem Owner-Builders as well as employers.a e I agree tonotiff the issuer of lhis form inlmediaiely;of ahi additions , deletions,.or changes lo any of tlie.informalion I 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 rinancial loss you may sustain as a result of a complainL Your only remedy against unllconsod Contractors may be in civil courl. lt is also important for you to understand that lf an unlicensed Contractor or employee of that individual or frm is iniured while worklng 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 thoss Contractors are propedy licensed and the stiatus of their workers' compensation insurance coverage. Before a huildlng pormit can bs issuad, thls form must be completod and signsd by the property owner and returnod to the agency aesponslble for lssulng tho p€rmlt. Note: A coov of the propetlv ownet's d ve,'s llcanse. form nota za. or propedv ownels slonaturo. Signature of Property Owner Oate:2-- Print name of Owner L 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 rollowing person(s) to act as my agent(s) to apply for, slgn, and lile the documents necessary to obtain an Owner-Builder Permit for my proiecL Scope of Construction Proiect (or Description of Work)SFc.Plo.s. rc\) Prolect Location or Address ?03 Name of Authorized Agent Address ol Authorized Agent 3'd Phone Number of Authoriz€d Agent:t I d€clare under penalty of periury that I am the property owner for the address listed above and I personally filled out the above infomation and certify its accuracy. Property Owne,'s Signature:") Print Name of Owner Nota: A copy ol the ownels drlver's llconse, form notarlzatlon, or othet vertflcatlon acceptable to tha agency ls r* qulrod to be presentad when the permlt ls lssued to vedfy the propetty owner's srgnature.