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Home My WebLink About1910 W Glenwood Pl - Misc. PermitI\4AYOR t\4iguelA. Pulido NIAYOR PBO TEM Michele Martinez COUNCILMEMBERS P. David Benavides Vicenle Sarmiento Jose Solorio SalTinajero Juan VilleOas CITY OF SANTA ANA PLANNINC & BUILDING ACENCY 20 Civic Center Plaza P.O. Box 1988 . Santa Ana, California 92702 www.santa-ana.orgl pba 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 improvements specified at I la {)27o ? We are providing you with an Owner-Builder Acknowledoment and lnlormation Verilication Form to make you aware ol 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: Bead and initial each statement below to signity you understand or verily this information. '@1. I understand a frequenl practice of unlicensed persons is to have lhe property owner obtain an "Owner-Builder" building permit thal 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. 5Z-z I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. dr- S. I understand as an "OwnerBuilder" I am the responsible party ol record on the permit. I understand that I may protect mysell from polential financial risk by hiring a licensed Contractor and having the permit liled in his or her name instead ol my own. 9* I undersland Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts, =-L5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the 6tal value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. -{.--^$. I understand iI 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 ablde by these laws may subject me to serious financial risk. fu\l understand under Calilornia Contractors' State License Law, an Owner-Builder who builds singleJamily residential structures cannot legally build them with the intent to ofler them for sale, unless a// work is performed by SANTA ANA CITY COUNCIL CITY MANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLEBK OF THE COUNCIL l\raria D. Huizar moulido@sanIa.ana oro lrayor Pro Tem, Wa/d 2 mlma.line2@santa ana.oro Vrcenre Sarmlento vsarmienlo@sanla-ana.oro l$k!i!@!aE!a:a!@ P Davd Benavides dbenav des@santa-a.a oro ivilleoas@santa-ana oro stinaierc@sanla'ana.oro 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' '7\8. I understand as an Owner-Builder il I sell the property for which this permit is issued, I may be held liable for any fin-ancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction delects in the workmanship or materials. .23 I understand I may obtain more information regarding my obligations as an "employei'from the lnternal Bevenue Service, tne Unlted States Small Business Administration, the California Department ol Benefit Payments, and the California Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-8OO-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. 3:1O I am aware of and consent to an OwnerBuilder building permit applied for in my name, and understand that I am the party I address: egally and financially responsible for propo sed construction activity at the lollowin A '%f1 I agree that, as the party legally and frnancially responsible ror this proposed construction activity, lwill abide by all applicable laws and requirements that govern Owner-Builders as well as employers. 'kl2.l agree to notify the issusr of this form immediately of any additions, deletions, or changes to any of the inlormation I have provided on this {orm. Licensed contractors are regulated by laws designed to protect the public. lf you contract wilh someone who does not have a license, the Contractrcrs' State License Board may be unable to assist you with any financial loss you may sustain as a resull of a complaint. Your only remedy against unlicensed Contraclors 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 6e iesp'onsible for verilying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building p ermit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Arote:A coDV of the proDertv owner's driver's license. form notarization or other verification to the aoencv is uired to be Drcsented when the Dermit is issued to verifv the D owner's sionature. Signature of Property Owner Date 4 --r) " /4 Print name of Owner -\n(( (, â‚¬ A/to R l:r r 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 lollowing-person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner Builder Permit ior my project. ScopeofconStrUctionProject{orDescriptlonolWork): Project Location or Address Name ol 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 f lled out the above information and certily its accuracy Property Owneas Signature Date Print Name of Owner Note: A copy ol the owner's driver's license, torm notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verity the property owner's signature. SANTA ANA CITY COUNCIL mpulido@sanra'ana.oro [,layor Pro Tem, Ward 2 m ma.l nez@sanla ana oro vrcente Sarmiento vsarh e.to@santa ana.oro lsd!i!@!3!l!:a!i P D.vid Aenavides dbenavrdes@sanla ana oro iv leoas@santa.ana.oro !]r!eie!!@s!!ta:e!a9!g