HomeMy WebLinkAbout2045 W Martha Ln - Misc. PermitMAYOR
MiguelA. Pulido
MAYOR PRO TEIV
t\,4ichele l\,4artinez
COUNCILMEIVlBERS
P. David Benavides
Vicente Sarmiento
Jose Solorio
SalTinajero
Juan Villegas CITY OF SANTA ANA
PLANNING & BUILDING ACENCY
20 Civic Center Plaza
P.O. Box 1988 .santa Ana, California 92702
www,santa-ana.orglpba
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 ^, )04f,aEf {r1u--at)"-lfu.,t-)0
We are providing you with an Owner-Builder Acknowledqment and lnlormation Veriflcation Form to make you aware of
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 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 verity this information.
,t'
/-l-$t1. f understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder"
qS0ilding permit that erroneously implies thal 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. Nily 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.
.\|U*' z. I understand building permits are not required to be signed by property owners unless they are responsible for
tli6 construction and are not hiring a licensed Contractor to assume this responsibility.
^.t0H" S. f understand as an "Owner-Buildel' I am the responsible party of record on the permit. I understand that I may
protect mysell from polential financial risk by hiring a licensed Contractor and having the permit filed in his or her name
inslead of my own.
lf,rLO I understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts
CITY MANAGER
Raul Godinez ll
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
l\,4aria D. Huizar
5. I understand if I employ or otherwise engage any persons, other than Calilornia licensed Contractors, and the
total 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.
(, \\-U , understand if I am considered an "employer" under state and Federal law, I must register with the state and
lederal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute 10
unemployment compensation of each "employee." I also understand my failure to abide by these laws may subject me to
serious financial risk.
\rM ,. I 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 lor sale, unless a//work is performed by
SANTA ANA CITY COUNCIL
{
moulido@sanla.ana.oro
Mayor Pro Tem, Ward 2
mimaninez@santa-ana oro vsa.mrenro@sanra ana oro lsolono@sanla ana oro
P Davrd Be.avides
dbenav des@santa-ara.oro iville.as@santa-ana.oro sl naiero@sanla.ana.oro
licensed subcontractors and the number ol structures does not exceed four within any calendar years, or all of the work is
performed under contract with a licensed general building Contractor.t\
4fSl , 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 lrom any lalent construction defects in the
workmanship or materials.
4f |[t. , understand I may oblain more information regarding my obligations as an "employea' from the lnternal Revenue
Service, the United States Small Business Administration, the California Department of Benefit Payments, and the
Calitornia 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.r)n JJ44t tt tO. I am aware of and consent to an OwnerBuilder building permit applied for in my name, and understand that I am
the party
address:
legall and f inanciall respo slble for prop osed construction activit v a the f llowin 06.01-r 6-
QtlLa,1. 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.Alr
UtsKt2 I agree lo 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, ths Contractors' State License Board may be unable to assist you with any linancial loss you may sustain
as a result of 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 ol 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. Arote.' A copv of the DroDertv ownet's driver's license.
tion or other to the ired to be ted when the it is
dto the ss,c/t/t rSignature of Property Owner Date:
Print name ol Owner
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 Permil for my
project.
Scope of Construction Project (or Description of Work)
Project Location or Address
Name ol Authorized Agent
Address of Authorized Agent
Phone Number ot Authorized Agent
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy.
Property Owner s Signature Date
Print Name of Owner
Note: A copy ol the owner's driver's license, lorm notarization, or other verification acceptable to the agency is required to
be presented when the permit is issued to verify the property owner's signature.
SANTA ANA CITY COUNC]L
mbuIdo@sanla-aoa oro
Mayor Pro Tenr ward 2
mimanne2@sania ara.oro vsarmiento@sanla ana.oro lsoor o@sa.la ana oro dbe.avdes@sanla a.a oro lyiXe@S@Sada:a!@ slrnaero@safla ana.oro