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Home My WebLink About1307 N Towner St - Misc. PermitPlannlng & Bullding Agency Bulldlng Sarely Dlvlslon 20 clvic Conler Plaza P.O. Box'1988 (M-lS) santa Ana, CA 92702 (714) 647-5800 www,santa-ana.org NOTICE TO PROPERW OWNER Dear Prop6rty Ownen r a buil dlno Dermit has beesI. -@21H16 der of the roperty lmprovementsn submitted in name listi you bu We are providing you wlth an Owner-Builder Acknowlsdoment and lnformation Verification Form to make you aware of your responsibllities and possible rlsk you may incur by having this permit lssued in your names as the Owner-Buildor. We will not issue a bulldlng permit untii you have râ‚¬ad, lnitialed your understanding of each provision, signed, and returned this form to us at our officlal address indicated. An agent of the owner cannot execute this notice unless you, the properly owner, obtaln the prior appoval of thB permltting authority. OW}IER'S ACKNOWLEGMENT AND VERIFICATION OF INFORMATON DIRECIIONS: Redd and lnltlal each statoment berow to slgnlfy you understand ot verify thls informallon. -'v t. I undersland a frsquent practice of unlicensed porsons is to have lhe property owner obtain an "Owner-Bulldef build- ing pâ‚¬rmlt that enoneously implies that the propâ‚¬rty owner ls providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subJect to serious flnancial risk for any lnjuries 6ustained by an unlicenssd psrson and hls or her employses while working on my property. My homeolvne,'s insurance may not provide coverage for those injuries. I am willfully acting as an Ownerâ‚¬uilder and am aware of the limits of my insurance coverage for injuries to workers on my prop- erty. Y-Z f undorstand bullding permits are nol required to be signod by properly owners unless they aro responslble for the constructlon and ara not hirlng a llcensed Contractor to assume this responsibility. ->L-, I understand as an 'Owner-BulEel- I arn the responsible party of record on the permit. I understand that I may protect myself from potential linanclal risk by hiring a llcensed Contraclor and havlng the permit flled in his or her name instead of my own. ]-4. f understand Contractors are required by law to be licensed and bonded in Californla and to list their license numbers 6i]-erm its and conka cts. \r-S. I underctand if I employ or otherwise engage any percons, other than CaliFomia licansed Conlractors, and the total value of my conslructlon is at lâ‚¬ast tlve hundred dollars ($500), lncluding labor and materials, I may be considerod an "emdoyor" under state and federal law. )j-o f understand if I am considered an "employer' under state and Fsderal law, I must reglster with the stats and fedsral governmenl withhold payroll taxes, pmvide workers' compensation disability insuranc6, and contribute to unemploymont com- pensation of aach "employee.' I also understand my failure to ablde by these laws may subject mo to serious llnancial risk. _7. I undershnd under Califotnia Contractors' Statâ‚¬ Llcsnse Law, an Owner-Builder who builds singlejamlly residential structures cannot legally build thom with tho Intent to offâ‚¬r them for sale, unless all work is performed by licensed subconbac- tors and the number of sfuclures doos not exceed lour within any calendar years, or all of lhe work is performed under contract with a licensed general buildlng Contractor. - 8. I understand as an Ownerâ‚¬uilder if I sell the property for which ffris permlt is issued, I may b6 held liable for any finan- cial or porsonal inJudos sushined by any subsequent ownâ‚¬r(s) that result from any lstent constructlon defects in tho workman- ship or matorials. APP"!3 CBC 2016 - Y 9. I understand I may obtain more information rogarding my obllgalions as En 'employâ‚¬/ from th6 lntemal Rovenus Se(- vlce, the United States Small Business Administration, the California Department of Eenallt Payments, and the Califomia Divi- sion of lndustrial Accidents, I also undsrstand I may contact thâ‚¬ California Contraclors' State Llcense Board (CSLB) at l -BOO- 32.1-CSLB (2752) or www.cslb.ca.oov tor more information about licens8d contractors. \ 10. I "rn "ware of and mnsent to an Owner-Bullder buildlng pemit appllâ‚¬d for in my namB, and understand that I am the party legally and flnancially responsible for propos6d construction activlly at ti6 folbwing ad- dr6ss: \.. 1.1.. l.agree that, as the party legally and flnancially responsible for thls proposed construction activity, I will ablde by all applicable laws and requlrements lhat govern Owner-Builders as well as employers. \ 12. lagreeto notlfy the issuer of thls lorm immedlately of any additions, doletions, orchangesto anyofthe informa on I have providad on this form. Licensed conbactors are regulated by laws designed to protâ‚¬ct the public. lf you contract with somoono who does not have a license, the Contractors' State Licsnse Board may be unable to a66lst you wlth any financial loss you may sustain as a result ol a complaint. Your only remedy againsl unlicensad Contractors may bB in civil court. lt is also important for you to understand that if an unllcensâ‚¬d contractor or employee of that individual or flrm is injured while worklng on your property, you may be held liable for damages. lf you oblain a perrnit as owner-Builder and wish to hire Contactors, you will be responsibG for verifying whether or not those contractors are properly licens6d and the status of their workors' compensation insurance coverage. Boforo 8 bulldlng permlt can be ls6ued, thls form must b to the agency 106ponslblo for lssulng tho permll, lrote.. I completod and slgned by tho proporty owner and returned A copy of the Drdoaft{ owner's drlve,'s license. fotm notarlza- fr/zr/e p rop e ttv ow n e f s s ld n atu re. Signature of Property Ownet Print name of Owner Vr Scopo of Construction ProJect (or Description of Work)EE- g-a-r? Date e4 AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Own6r, the axecution o, which I undeBtand is my personal responsibility, I hBreby authorize the following person(s) lo act as my agent(s) to apply for, slgn, and file the documents necessary to obtain an Owner-Builder Pormit for my project Project Location or Address:la:, x.l. -rep^.we.- sr. grr-^ r'0+"-C^ Name of Authorlzgd Agâ‚¬nt: Address of Authorizod Ags Phone Number of Authorized Agenl I declale under penalty of per.iury th m the property own6r for the ss listed above and I personally lllled oul he above information and certify its accura Da*: /o'22 nProperty Owne/s Slgnature: Print Name ot Owner:\./l t t Note: A copy of tho ownelg ddvels llcense, form notalization, or othsr verlticatlon acceptable to the agency ls t* qulred to ba presented whsn the permlt ls lssued to vortty the property ownst"s slgnature,