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Home My WebLink About1809 W Glenwood Pl - Misc. PermitMAYOR N/iguelA. Pulido MAYOB PRO TEI\.4 Michele l\rartinez COUNCILI\,4EN,llBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinalero Juan Villegas CITY OF SANTA ANA PLANNINC & BUILDING ACENCY 20 Civic Center Plaza P.O. Box 1988 . Sanra Ana. California 92702 www.Santa-ana.org/ pba NOTICE TO PROPERTY OWNER Dear Property Owner An application for a building permit has been submitted in your name listing yoursell as the builder of the property improvements specified ut rgce ut> .Ctrenurcrj D i 6Gn\c. Arva t A Cz-.zo\ OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signity you understand or verity this intormation. 1l \r . r understand a f requent practice of unlicensed persons is to have the property owner obtain an "Owner-Buildei' bui[ding permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, 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. , 1J). I understand building permirs are not required to be signed by property owners unless they are responsible for the construction and are not hiring a Iicensed Contractor to assume this responsibility. , / /-1.r. I understand as an 'Owner-Buildei' I am the responsible party of record on the permit. I understand that I may/ frot6ct myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead ol my own. ,, / i>+ I understand Contractors are required by law to be licensed and bonded in California and to list their license nuffbers on permits and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the tot 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. lJj. I understand if I am considered an "employer" under state and Federal law, I must register with the state and' led6ral government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation ol each "employee." I also understand my lailure to abide by these laws may subject me to serious financial risk. /{t L t )7. I understand under Calilornia Contractors' State License Law, an Owner-Builder who builds singleJamily residential structures cannot legally build them with the inlent to offer them for sale, unless a//work is performed by SANTA ANA CITY COUNCIL CIry MANAGER Raul Godinez ll CIry ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL l\,4aria D. Huizar moulldords6.ta-ana oro Mayor P.o Teh, Ward 2 m han nez@sanla ana oro Vl.ente Sarmicnr. vsarmlenlo@santa a.a.oro We are providing you with an Owner-Builder Acknowledoment 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 lorm 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 lhe permitting authorily- isolorio@sanra-ana.oro P oavd Benavides dbenaedes@sanIa-ana.oro iv eoas@sanla'ana oro slinaiero@sanla.ana.oro licensed subcontractors and the number ol structures does noi exceed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. .4 (' 44. I understand as an Owner-Builder i{ I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result {rom any latent construclion defects in the workmanship or materials. /!a:F. I understand I may obtain more information regarding my obligalions as an "employer" from the lnternal Revenue Serr/rce, the United States Small Business Administration, the Calilornia 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 1-800-32'1-CSLB (2752) or w1i\,1 .cslb.ca.oov for more inlormation about licensed contractors. /{-l.:=tl"the party address: I am aware of and consent to an Owner-Builder building permit applied lor in my name, and understand that I am leg all and financial responsible f or p ro p osed construction activity at the following -L:)1.1 agree that, as the party legally and financially responsible for this proposed construclion activity, I will abide by rall aFplicable laws and requirements that govern Owner-Builders as well as employers. ,. /J_Li2 I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any ol the/ inf ormation I have provided on this f orm. 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 ol 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 lirm is injured while working on your property, you may be held liable for damages. ll you obtain a permit as Owner-Builder 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' compensalion 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 issuin it. A/ofe.' A coDv of the Dropeftv owner's driver's license, za tion or other veritica ,s uired to when t issued to veri the o s re Signature of Property Print name of Owner Owner r Date:5)t )zot? ,e.\ AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of whlch I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply ior, sign, and lile the documents necessary lo obtain an Owner-Builder Perm t lor my proiect. Scope of Construction Project (or Description of Work) Projecl Location or Address Name of Authorized Aoent Address of Authorized Aoent I declare under penalty of perjury thal I am the property owner for the address listed above and I personally filled out the above informalion and certify its accuracy. Properly Owner's Signature Date Print Name oi Owner: Note: A copy of the ownet's d ver's license,lorm notarization, or other veritication acceptable lo lhe agency is required to be presented when the permit is issued to verity the propeiy owner's signature- ') ,i.j'\": .1r,. i.r.. ii.-r'rrri ! ,. :i.ii.i..:, irt: r'ir- irllii SANTA ANA CITY COUNCIL moul dd(asanla.ana oio Mayor Pro Tem. ward 2 minan neu @sa.la ana.oro vcente Sarmienro vsam enlo@sanla-ana.oro solorio@sanla-ana oro d!eE!.0es@s?!E:3 I'lleoas@santa-ana.oro slrnaiero@sanla-ana.oro Phone Number ol Authorized Agenl: