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Home My WebLink About1971 E Seventeenth St Unit# A - Misc. PermitI\,4AYOR N,'liquel A. Pulido MAYOR PRO TEM Michele Martinez COUNCILMEMBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY MANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar CITY OF SANTA ANA PLANNING & BUILDINC ACENCY 20 Civic Center Plaza P.O. Box I 988 . Santa 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 yourself as the builder of the property lq+l E.s+ l':llh .S*r-c,l - Srrt{e A -ScrnL Anr.CA qa:}oS 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 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. ow NER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. -..--'-//r. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" 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 for any injuries sustained by an uniicensed 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 Aers on my propertY. 7' Z. I understand building permits are not required to be signed by property owners unlesstheyare responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. -'-?( l" 3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may proG;t myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. I understand Contractors are required by law to be licensed and bonded in California and to list their license mbers on permits and contracts ,-...' ElS I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and thecfotal 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 if I am considered an "employer" under state and Federal law, I must register with the state and eral government, withhold payroll taxes, provide workers' com pensation 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. & , understand under California Contractors' State.License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by SANTA ANA CITY COUNCIL 6o ono@sa.ta-a.a oromoulido@santa ana.oro Mchee Martinez Mayo. Pro Tem, ward 2 mimaninâ‚¬z@santa ane oro vicente s6rmiento vsarmienlo@santa+na.oro P. OEv'd BenEvldes dbenavides@santa-ana.oro ivirreoas@santa-ana.oro sl naiero@santa-ana.oro improvements specified at 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. _/-A t understand as an Owner-Builder if 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 from any latent construction defects in the workmanship or materials. r' S I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Service, 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 (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. / 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 at the following address: tq trt ELS{ llth S{r c--l -Sg.ile,A- Scn.la Aoc <A q2.?6.S - 11. 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 govern Owner-Builders as well as employers. r' lZ.l 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 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 asaresultof a complaint. Youronly remedy against unlicensed Contractors maybe in civil court. ll 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 be responsible for verifying 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 for issuing the Permit. /Vo(ej A coDv of the oroDertv wner's driver's license- form notarization, or other verification acceptable to the aqencv is reduired to be presented when the permit is Signature of Property Owner e"1". '{f ro tq Print name of Owner lYlic tz (flr*./rnlqr'o 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 person(s)to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work)6a* (Ylater Rc lccse O uL.t Project Location or Addressl lqll E.c+ lqth S{rcG+ - Suik A- Ssn{r Anc cA qa:los Name of Authorized Agent:Amg\{otrtc ls - Sc,.r-{hcr Address of Authorizeo agent: tZ}l{ Els* l?+h s'tre.. { 'SAolaAne CA 9a1ol Phone Number of Authorized Agent r{tl('o- lSoS CcLl:.{q 35co18+ I declare under penalty of perjury that I am the er for the address listed above and I personally filled out the above .1lrr.ltq Property Owner's Signature:Date Print Name of Owner: Note: A copy of the owner's driver's license, form notarizalion, or other verification ac to the agency is required to be presented when the permit is issued to verify the propefty owner's signature. P. i['r'.]p51,4)o!nierA.!rvity Assenbrle, slNo:i.e lo Properv I o:n 0,' 14 :l:.16 SANTA ANA CITY COUNCIL moulido@san1a-ana.oro MlcheLe Msd.ez fi,layor Pro Tem Ward 2 miman nez@sante-ana oro Vice.te Sam ento vsarmiento@sants-ana,oro isolorlolosanta-6na.oro dbenavrdes@sanlr-ana.ora v I eoasrOsanta-ana,oro siinai6.o@santa-ana.oro issued to verifu the Dropetfu owner's siqnature. information and certify its accuracy. foic.lrae \ tYl uqe,1 /-s^^ Aq{onlo S6r, Aera, LA