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Home My WebLink About2020 W Camden Pl - Misc. PermitIVAYOB i.4iguelA. Pulido MAYOR PRO TEM Michele Madinez COUNCILMEMBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY I\,4ANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL l\,4aria D. Huizar oPerty 1(-rz,.-t C..-rt CITY OF SANTA ANA PI-ANNING & BUILDINC AGENCY 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 pr improvements specilied at ZD \). CAun-oe^l VL Sc^,wl.qzloLl We are providing you with an Owner-Builder Acknowledoment and lnformation 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 OwnerBuilder. We will not issue a building permit untll you have read, initialed your understanding of each provision, signed, and returned this form to us at our o{licial address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval ol the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON DIR!ECTIONS: Bead and initial each statement below to signify you understand or verify this intomation, l/ 't . I understand a lrequent 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 unlicensed person and his or her employees while working on my property. lvly homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware ol the limits of my insurance coverage for injuries to workers on my property. /-l--". 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. I understand as an "Owner-Builder" I am the responsible party ol record on the permit. I understand that I may rotect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own 4. I understand Contraclors are r equired by law to be licensed and bonded in California and to list their license num bers on permits and contracts un derstand if I employ or otherwise engage any persons, other than California licensed Contractors, and the value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "em ployer" 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' compensation disabillty 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.rli I /V. l understand underCalifornia Contractors' State License Law, an Owner-Builder who builds singlejamily rHidential slructures cannot legally build them with the intent to offer them for sale, unless a//work is performed by SANTA ANA CITY COUNCIL moulido@sanla-a.a.o.o Mayor Pro Tem, Ward 2 m ma.l nez@san16.ana.oro isolono@santa.ana.oro P Oavid Benavdes dbenavdes@sanla.ana.orc iv lleoas@sanra-Ena dro sllnaiero@santa'ana.oro Vrcante Sarmie.lo vsarmienlo@santa-ana.o16 licensed subcontractors and the number of structur6s does not exceed lour within any calendar years, or all of the work is pergrmed under contract with a licensed general building Contractor./t., -aY I undersland as an OwnerBuilder il I sell the property lor which this permit is issued, I may be held liable for any linancial or personal injuries sustained by any subsequent owne(s) that result Irom any latent construction defects in the workmanshio or materials.ft" L// g. 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 Benefil Payments, and the California Division of lndustrial Accidents. I also undersland I may contact the California Contractors' State License Board (CS^LB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors.r' t_/z{6.1 am aware of and consent to an Owner-Builder building permit applied lor in my name, and understand that I am th-e parly legally and financially responsible for proposed construction activity at the following address:/^/ l/ r-- | ,^-/ 11.1 agree thal, as the party legally and financially responsible lor this proposed conslruction activity, I will abide by -all applicable laws and requirements lhat govern Owner-Builders as well as employers. I agree to notify the issuer ol this lorm immediately of any additions, deletions, or changes to any of the ormation I have provided on this {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 linancial 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 firm is injured while working on your property, you may be held liable for damages. lf you obtain a permit as OwnerBuilder 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 lorm must be completed and signed by the property owner and returned to the agency responsible lor issuing the permii- Nofe.' A coDv of the DroDertv owner's driver's license. torm notarization, or othet verification acceptable to the agency is required to be presented l4belthe pelnlt ls ,s owner'.re. Signature of Property Owner Date:f -t4- tt Print name of Owner 4rtic (q C,\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 ol Construction Project (or Description ot Work) Project Location or Address Address of Authorized Agent Phone Number of Authorized Agent Ideclare under penalty of perjury that I am the property owner lor the address listed above and I personally filled out the above inlormalion and certify its accuracy. Date Print Name of Owner Note: A copy of the owner's driver's license, torm notarization, or other verilication acceptable to the agency is required to le lresented wh:n lhe p.e:m.it !?,issued lo verify the property owner's signature. SANTA ANA C TY COUNCIL moul do@sanla'ana oro Mayor Pro Tem. Ward 2 himanrnez@sarta.ana oro vsarmre.ro@sanla ana oro isolono@sanla-ana oro P. Oavd Benavrdes dbenavides@sanla-ana.oro Name of Aulhorized Agent: Property Owner's Signature: .luan villegas saiTlnajerc Ward 5 Wa.d 6 ivilleoas@santa-ana.oro srinaiero@sanra-ana.o.o