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Home My WebLink About1920 W Maywood Ave - Misc. PermitI\,1AYOR Miguel A. Pulido I,IAYOR PRO TEIV Michele Marlinez COUNCILIVEN,llBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Vilegas CITY OF SANTA ANA PLANNING & BUILDING AGENCY 20 Civic Center Plaza P.O. Box 1988 . Santa Ana, California 92702 www.Santa-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 imorovements soecif ied at-'tqJo Q ^,44Y 2)0.1 We are providing you with an Owner-Builder Acknowledoment and lnlormation Veri{ication 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. .ntH t. t understand a trequent practice ol unlicensed persons is to have the property owner obtain an "Owner-Buildei' building 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 lor 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 willlully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries 10 workers on my property. TN Z. t understand building permits are not required to be signed by property owners unless they are responsible for , the construction and are nol hiring a licensed Contraclor to assume this responsibility. h[--e. I understand as an "Owner-Buildea' I am the responsible party of record on the permit. I understand that-l may protect myself from polential financial risk by hiring a licensed Contractor and havrng the permit filed in his or her name instead of my own. 1t(-0. f understand Contractors are required by law to be licensed and bonded in Calilornia and to list their license n,rm-bers on permils and contracts. t0fl_5. I undersland if I employ or otherwise engage any persons, other than Calilornia licensed Contractors, and the total value ol my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. o #--o. I understand if 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 abide by these laws may subject me to serious financial risk. 1TI Z. t understand under California Contraclors' State License Law, an Owner-Builder who builds singleJamily residential structures cannot legally build them with the intent to olrer them for sale, unless a//work is performed by SANTA ANA CITY COUNCIL CITY MANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL lvlaria D- Huizar Ep!ld!@!a!Ia:a!r,o!q Mayor Pro Tem, Ward 2 m martine2@sanla ana.oro vsarmienlo@sanla.ara oro lsd!i!@!aqa:a!a dbenavides@santa ana oro iyi.IeCas@s.alla:ali sl naiero@sanla ana.oro licensed subcontractors and the number of structures does not ex:eed toir within any calendar years, or all ol the work is performed under contract with a licensed general building Contractor. -rff 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable lor any Iin-ancial or personal injuries sustained by any subsequent owne(s) that result from any latent construclion defects in the workmanship or materials. t( g. t understand I may obtain more information regarding my obligations as an "employea'f rom the lnternal Revenue Service, the United States Small Business Administration, the California Department ol Benefit Payments, and the California Division ol 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.oov for more information about licensed contractors. ,/)1ff lO.I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity al the following +t{ f t. I agree that, as the pady legally and financially responsible for this proposed conslruction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. 'tK p.I agree to notity the issuer of this form immediately of any additions, deletions, or changes to any ol the information 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 of a complaint. Your only remedy against unlicensed Contractors may be in clvil court. lt is also important for you to understand that il an unlicensed Contractor or employee of that individual or firm 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 verilying whether or not those Contractors are properly licensed and the status of their workers' compensation 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 lor issuing the permit. /Vote.' A coDv ol the propertv owner's driver's license. r ther verification the ,s ul when the ,s o si natu address: Signature of Property Owner Pnn: name ol Uwner -r-1u tâ‚¬tJ -'t*NJ -tl ?+lMt4 ' 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 pArson(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit lor my project. Scope of Construction Project (or Description of Work) Prolect Location or Address Address ol Authorized Agent: Phone Number of Authorlzed Agent I declare under penalty of perjury that I am the property owner for the address lisled above and I personally filled out the above information and certify its accuracy. Property Owner's Signature Date Print Name ol Owner Note: A copy ol the owner's driver's license, form notarization, or other verilication acceptable to the agency is required to be presented when the permit is issued to verify lhe property owner's signature. SANTA ANA CI'IY COUNCIL mpuldo@sanra ana.oro Mayor Pro Tem. Ward 2 mrmaninez@sanra ana.oro vrcenle Sarmrenro vsarm erlo@sanra ana.oro P. Davld Benavrdes dbe.avdas@sarla.ana.oro $!eis!@seda:a!a4lgisolono@sanra ana oro iv eoaslasanta ana oro Name of Authorized Agent: -