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Home My WebLink About1610 N Mabury St - Misc. PermitMAYOR Miguel A. Pulido MAYOR PRO TEM Michele Martinez COUNCILMEMBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY IV]ANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar CITY OF SANTA ANA PLANNING & BUILDING ACENCY 20 Civic Center Plaza P.O. Box 1988 . Santa Ana. California 92702 www.5anta-ana.or9/ pba 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 tmp em nts S ecified at We are providing you with an Owner-Builder Acknowledqment and lnformation 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 INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand or verify this information._z {O. ,understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder"'bIilding 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. M)_r. ,understand building permits are not required to be signed by property owners unless they are responsible for 'th"e construction and are not hiring a licensed Contractor to assume this responsibility. a4- [r'f,)I Iunderstand as an "Owner-Builder" Iam the responsible party of record on the permit. I understand that I may ffiect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. I Jnderstand Contractors are required by law to be licensed and bonded in California and to list their license ers on permits and contractsU 5. I understand if lem ploy or otherwise engage any persons, other than California licensed Contractors, and the value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an SANTA ANA C TY COUNCIL mou I do@santa-ana oro Mayor Pro Tem, ward 2 mimarlinez@santa ana oro Vrcente Sarmrenlo vsarmienro@sanla-ana oro l!9Ls!i9@!!!1!:4!.9!s dbe.av des@sanla-ana.oro iv leoas@santa ana.oro sl.a eroasanla-ana.oro a "employer" under state and federal law. t1OA. I understand if I am considered an "employer' under state and Federal law, I must register with the state and lMp/al 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. .^ /1r v./-\K[. t I . I understand under California Contractors' State License Law, an Owner-Builder who builds single-family teXidential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by 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. 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 tnancta I or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or materials 9. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue ice, 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.qov for more information about licensed contractors. 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am'e party I lly and financially resp ons ible proposed construction activi at the following address '11. I agree that, as the party legally and financially responsible for this proposed construction aclivity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers 12. I agree to notify the issuer of this form im mediately of any additions, deletions, or changes to any of the orm ation 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 b9 responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' ., A o6mpensation 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. Nofe;A coDv of the DroDertv ner's driver's license, form notarization or other verification to be sented when the ermit is issued to the i/ Print name of Owner 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 for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work)I 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 Illled out the above informalion and certify its accuracy Date: Print Name of Owner: arization, or other verification acceptable to the agency is required to be presented when t,il ,s ,ssued to fy properly owne r's si g nature. PLrnk rVJP5 r /CoLr.tciAcnvity/AssenbryBrlrs/No1 ce lo Propeny Fo.m (13-14-?0i6 SANTA ANA CITY COUNCIL mouidoaasanra-ana.oro Mayor Pro Tsm, W6rd 2 m rnan nez@santa-a.a oro Vicenre Sarmienlo vsarmienlo@sanla-ana oro sororio@sanla-a.a oro v eoas@sanla ana.oro stina ero@santa-ana.oro Project Location or Address: P. Oavid Benavides dbenavrdes@sanla-Bna oro