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Home My WebLink About1615 S Birch St - Misc. PermitMAYOR Miguel A. Pulido I\,IAYOR PRO TEIV Michele l\.4artinez COUNCILIVIEl,llBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY [,4ANAGEB Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL l\.4aria D. Huizar CITY OF SANTA ANA PLANNINC & BUILDINC ACENCY 20 Civic Center Plaza P.O. Box 1988 . Sanra Ana, California 92702 www.santa-ana.orglpba NOTICE TO PROPERTY OWNER Dear Property Owner An application lor a building permit has been submitted in your name listing yourself as the builder of the property imorovements soecif ied at' /0 t < 'S.6i'c-t" > i ?anl,"^ A-rv^ <z<- a)1o 1 We are providing you with an Owner-Builder Acknowledqment and lnlormation Verification Form to make you aware of your respons;bilities and possible risk you may incur by having this permit issued in your names as the OwnerBuilder 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 ol the owner cannol execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. o ER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON DI TIONS: Bead and initial each statement below to signify you understand or verity this intormation. u ln 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" g 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. lrily homeowner's insurance may not provide coverage for tho e injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to on my property 2. I understand building permits are not required to be signed by property owners unless they are responsible for e o struction and are not hiring a licensed Contractor to assume this responsibility p . I understand as an "Owner-Builder" I am the responsible parly of record on the permit. I understand that I may myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name d ol my own . I understand Contractors are required by law to be licensed and bonded in Calilornia and lo list their license m rs on permits and contracts understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the lue of my conslruction is at least five hundred dollars ($500), including labor and materials, I may be considered an " under state and federal law. understand il I am considered an "employer" under state and Federal law, I must register with the state and lgovernment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to UN m loyment compensation of each "employee." I also understand my failure to abide by these laws may subject me to sefl s f inancial risk entl I understand under California Contractors' State License Law, an Owner-Builder who builds single-{amily al slructures cannot legally build them with the intent to offer them for sale, unless a//work is performed by SANTA ANA CITY COUNCIL Eqrlla@sada:aorprg Mayor Pro Tem, Ward 2 mimaninez{Asarta-ana oro vsarmenlo@santa.anao.o isolorlo@sanra.ana.oro P David Ben.vder dbenavides@sanb ana oro jvteles@sa4a:eE4lc sinaie16@santa'ana ord licensed subcontractors and the number of structures does not exceed Iour within any calendar years, or all of the work is perf m ed under contract with a licensed general building Contractor I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any 1i ncial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the m ship or materials o I understand I may obtain more information regarding my obligations as an "employea'from the lnternal Bevenue 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 (CS B) at 'l -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 party legally and financially respo n sibl .â‚¬+p roposed construction activity at the followin s dr 1. I agree that, as the party legally and linancially responsible for this proposed constructlon activity, I will abide by licable laws and requirements that govern Owner-Builders as well as employers agree to notify the issuer of this form immediately of any additions, deletions, or changes to any ol the ation I have provided on this form icensed contractors are regulated by laws designed to protect the public. ll 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 lo understand that il an unlicensed Contractor or employee ol that individual or lirm is injured while working on your property, you may be held liable Ior damages. lf you obtain a permit as OwnerBuilder and wish to hire Contactors, you will be responsible for verilying whether or not those Contractors are properly licensed and the status ol their workers' compensation insurance coverage. Before a building permit can be issued, this lorm must be completed and signed by the property owner and returned to the agency responsible fo r issuing t permit. Arote: A copv of the propertv owner's driver's license. rm other veri to the ,s uired to be resented when the It is ven the o Signature of Property Date c*"/t * Print name ol Own Ll)7-7 AU ORIZATION 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 1or, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description ol Work) Project Location or Address Name of Authorized Agent Address of Authorized Agent Phone Number of Authorized Agent ldeclare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certily its accuracy. Property Owneas Signature Date Print Name ol Owner Note: A copy ol the owner's driver's license, form nolarizalion, or other verificalion acceptable to the agency is required to be presented when the permit is issued to verity the properly owner's signature. SANTA ANA CITY COUNCIL mour do@sanla-an a.oro Mayor P.o Tem. Ward 2 m martrne2@sanla'ana oro vsarmlenro@sanra ana.ora solono@sanra.ana.oro dbenavrdes@sarra.ana oro iv lleoas@santa.ana oro sr naiero@sanra'ana oro t