The URL can be used to link to this page

Home My WebLink About1440 S Broadway - Misc. PermitMAYOR N4iguel A. Pulido MAYOR PRO TEM Michele Martinez CO U NCIL IVIE IVIB E RS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY OF SANTA ANA PLANNING & BUILDING AGENCY 20 Civic Center Plaza P.O. Box 1988 . Santa Ana. California 92702 www.santa-ana.org / pba NOTICE TO PROPERTY OWNER Dear Property Owner An appljcation for a building perm it has been submitted in your name listing yourself as the builder of the property CITY IVIANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar improvements specified at /I o/ We are providing you with an Owner-Builder Acknowledoment and Information Verification Form to make you aware of your responsibilities and possible 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 ACKNOWLEDGMENT AND VERIFICATION OF IN F o RMATON DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. erstand a frequent practice of unlicensed persons is lo have the property owner obtain an "Owner-Builder' bu s 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. ,4.2 -fV'z- I understand building permits are not required to be signed by property owners unless they are responsible for/tlMnstruction and are not hiring a licensed Contractor to assume this responsibility. /Z *l understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may / pi-olect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. understand Contractors are required by law to be licensed and bonded in California and to list their license NU bers on permits and contracts nderstand 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. /.r , /(4!,2Q:funderstand 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' 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 financial risk. 1 entia understand under California Contractors' State License Law, an Owner-Builder who builds single-family I structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by SANTA ANA CITY COUNCIL mo! do@sanra-a.a oro Mayor Pro Tem, Ward 2 m ma.l nez@sanlaina oro vsarmienro@santa-ana o.o isolono@sanla'a.a.oro P. Oavd Benavdes dbenavides@sanla-ans.ora v eoaslasanta-ana oro stinaierolasaola ana.o.o 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 Contractor. understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any nc ial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or materials. .LZS t understand I may obtain more information regarding my obligations as an 'employer" from the lnternal Revenue SeMce, 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 W1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am egally and fina nciall y responsr for sed constr uctio'&+-n activ at the followi address s t I ree that, as the party legally and financially responsible for this proposed construction activity, I will abide by laws and requirements that govern Owner-Builders as well as employers.ca ble t,/,,2 /-!!Z.l a$ee to notify the issuer of this form immediately of any additions, deletions, or changes to any of the "infoi-mation 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 OwnerBuilder 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 permit : A coDv of the Drooertv owner's driver's license- notarization or other verification le to n when it is issued to the owner's Signature of Property Print name of Owner Owner Date t/rs/n a-lJJc- Ut t:ttt,"-fl^,ri' A HORIZATION F AGE 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 for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project Scope of Construction Project (or Description of Work)r; rry"h^ oy' 17ia2 a4J v- Project Location or Address va)5 c4 2 o-7 Name of Authorized Agent Address of Authorized Agent:@7oz@ Phone Number of Authorized Agent I declare under penalty of perjury that I am the pe er for t address and I personally filled out the above information and certif,/ its ac Property Owner's Signature: curacy Date Print Name of Owner: Nole: A copy of the owner's s license, form no nza oro ve rific ati on acce ptable agency be presented when the permit is issued to yerify the owner's signature,p r[ yr,9: ]ra.Nrl,., A.!,riilLrsrrrrlrit :,],tol,.! l. r,r"p.iv f ..r l,ir ri :ri tri SANTA ANA CITY COUNCIL mpLrlidolosanls-ana oro Mayor Pro Tem Ward 2 mimadi.ez@sanla-ana.oro !sarm'enlo@sa.l3.ana oro Eolonolosa.ls-ana.oro P DaMd Benavdes dbenavidesaasanta ana.o.o lvilleoas@sanla-ana oro slrnaero@'sanla-ana oro )Ab is required to /