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HomeMy WebLinkAbout1710 W Eleventh St - Misc. PermitPlannlng & Building Agency Bulldlng Safety Division 20 Civic Contar Plaza P.o. Box '1988 (M-19) Santr Ana, CA 92702 Fl/r) 647-5800 urww.santa-ana.org APP-{3 CBC 2016 NOTICE TO PROPERTY OWNER Dear Property Owner: An applicatio specified at n for a building permit has been submitted i 1710 W 1 1TH STREET SANTA AN CA n your 92703 name listing yourself as the buildet of the property improvements We are providing you wilh an Owner-Builder Acknowledoment and lnformation Verilication Form to make you aware ot 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 ofiicial addrcss indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWl{ER'S ACKI{OWLEG EI{T AI{D VERIFICATION OF II{FORTATON DTRECTTONS: Reed and inillal eech st,/lement below to slgnw you understand or vatw lh/E lnformd$on, DD t. t undersland a frequent praclice of unlicensed peBons is to have the property owner obtain an "Owner-Buildef bulld- ing plrmit that enoncoudy 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 sub,iec't to serious financial risk for any injuries sustained by an unlicensed person and his or her cmployees while working on my property. My homeomefs insurancc may not provide coverage tor those injuries. I am willfully acting as an Owner€uilder and am aware of the limits of my insurance coverage for in uries to workers on my ProF erty. !9-2. f understand building permits arc not required to be signed by property owners unless thcy are responsible for the construction and are not hiring a licensed Contrastor to assume this responsibility. 99-g. f understand as an "Owner-Buildea I am tho responsible party of record on the permit. I understand that I may protect my3elf ftom potential financial risk by hiring a licensed Conhaclor and having the permit filed in his or her name instead of my own. OD +. f understand ContEctors are required by law to be licensed and bonded in Califomia and to list their license numbers on permits and contracls. DD S. t undeBtand if I employ or otheruvise engage any persons, other than Califomia licensed Contractors, and the total value of my construction is at least tive hundred dollaB ($500), including labor and materials, I may be considered an 'employef under state and federal law. !9-0. f understand if I am considered an 'employer' under state and Federal law, I must register with the state and federal govemment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment com- pensation of each 'employee.' I also understand my failure to abide by these laws may subiec't me to serious financial risk. LZ. f understand under Califomia Contraclors' State License Law an Owner-Builder who builds Bingle-family residential structures cannot legally build them with thc intent to offer them for sale, unless a/ work is performed by licensed subcontrac- tors and the number of struc{ures does not exceed four within any calendar yeaG, or all of the work is performed under contrac{ with a licenged general building Contractor. DD g. t underctand as an Owner-Builder if I sell the propcrty for which this permit is issued, I may be held liable for any finan- cial or pcrsonal injuries sustained by any subsequent owner(s) that resull from any latent const uction detecls in the workma n- ship or materials. _80,_S. t understand I may obtain more information regarding myobligations as an'employef from the lnternal Revenue Ser- vice, the United States Small Business Administration, the Califomia Department of Benefit Payments, and the Califomia Divi- sion of lndustrial Accidents. I also understand I may contacl the Califomia Contractors' State License Board (CSLB) at 1-80G 321-CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors. _QLl o I am aware of and consent to an Owner-Builder building permit applied for in my name, and undersland that I am the party legally and financially responsible for proposed construction activity at the following ad- dress: . DD 1 f. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govem Owner-Builders as u/ell as employeB. _q912. I agree to notiFy the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contadors are regulated by laws designed to protect the public. lf you contract Wth someone who does not have a license, the ContractoB' State License Board may be unable to assist you with any linancial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil courl. lt is also important for you to understand that if an unlic€nsed Contractor or employee of that individual or frm is injured wtlile working on your property, you may be held liable for damages. lf you obtain a permit as Owner-Builder and Wsh 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. Botoro a building pomlt can bo is3uod, thl3 fo]m murt bo comploted and 3ignod by the property ownor and rotumsd to the agoncy rcsponsible for l3sulng tho pormit Note: tlon. ot othet verillcatton acceotdble to the aoencv ls tBoulrl|d to be presented when the oermlt ls lasued ao vedfv the Signature of Property Owner oarre. 4t24n020 Print name of Owner DUNG DO AUTHORIZATION OF AGENT TO ACT ON PROPERry OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of wtrich I understand is my personal responsibility, I hereby authorize the following person(s) to acl as my agent(s) to apply for, sign, and file thc documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Projecl (or Description of work):275 SQUARE FEET WORKSHOP Proiect Location or Address 1710 W 11TH STREET SANTA ANA, CA 92703 Name of Authorized Agent:ouoc Do Address of Aulhorized Agent:121 8 CAMDEN PL SANTA ANA, CA 92705 Phone Number of Authorized Agent: I declare under penalty of pedury that I am the property owner for the address listed above and I personally lilled out the above information and certify its accuracy. Property Owne/s Signature Date 4t2412020 Print Name of Owner:DUNG DO Note: A copy of the ownef s drlverls license, form notartza0on, or other verlfica0on acceptable to the dgency is re- qulrcd to be presented whan the pe'7,,it is bsued to verily ahe propefty owner's slgnature.