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Home My WebLink About2102 W Washington Ave - Misc. Permitt Plannino & Building Agency Building Safety Division 20 Civic Center Plaza P.O. Borl96E (M-19) Sania Ana, CA 92702 (7r4) 647-5E00 www.santa-ana,org f*4re5'f ' @f-r.rt{ (oe tor\oto2\ APP-I3 CBC 20.t6 NOTICE TO PROPERTY OWNER Dear Properly Owner: An applicat ion for a buildi ng has nsu itted i your na yo as the bui of property im provements specified at We are pmriding you with an Owner-Buildgr Acl(nqwledoment and lnformation Verification Form to make you aware of your responsibilities and possible risk you may incur by having lhis permit issued in your names as ttre Ownor-6uider. we will not issuo a hlilding permit until you have read, initialed your understanding of each proMsion, sllned, and retumed this form to us al our official address indicated. An agent of the owner cannot execute this notice unlass you, the property owner, oblain the prior approval ofthe permitting authority. OWNER'S ACKNOWLEGMENT VERIFICATION OF INFORMATON DrFEcrrolrs: React and iniflal each stalc.ment lr.torr to stgn/fy you undersland d veity this tntor,rnaaon. --?.)(J2Ll I understand a frequent practice of unlicensed persons is to have the properry o\yner obtain an.Owner-Buihoa build- ing permit that enoneously implies that the property owner is providing his or her own labor and material personally. l, as an Olvner-BuiHer, may be held liable and subjecl to serious financial rbk for any injuries sustained by an uniicensed ierson andhb or hâ‚¬r employees while working on my property. My homeowneis insurance may not provide covBrage for those injuries. I am willfully actinq as an OwnerSuilder and am aware of the limits of my insurance co\rerage for iniuries to workers on my prop erty. -?/?(r'42. I underslaM building permits are nol requirod to be signed by property owners unless they are responsible brth6 construclion and are not hiring a licensed Contractor to assume lhis responslbility. -?ztCJ4?: I understand as an 'Owner-Buildef lam the responsible party of recod on the permit. I understand that I may protect mysetf trom potential nnancial risk by hiring a licensed Conlractor and having the permit filed in his or her name instead of my own. &, I undorstand contractors are râ‚¬quirBd by law to be licensed and bonded in catifomia ond to list their ticâ‚¬nse numbers on pemits and comracts. --O2CL W I understand if I employ or otheMise engage any persons, other than Califomia licensod Cor[ractors, and the totat value 6f my conslruclion is al leasl five hundred dollars ($500), including labor and materials, I may be considered an'employef under stale and federal law. --?a7{$A. t understand if lam consireted an "employer" under stale and Federallaw, lmust register with the state and federal govemment, withhokt parolllaxes, provide workers' compensation disability insurance, and contribute lo unemployment com- pensalion of each 'employee." I abo understand my failure to abade by these lavrrs mey subjecl me to serious financial risk. --.r2-2I L4l . t unaerstaM under Califomia conlrac{ors' Stale Liconse Law, an Owner-Builder who builds singlo-family rBsktontiat strudures cannol legally build them with the intent to offurthem for sale, unless a/ work b performed by licensod subcont-ao tors and the number of strudures does not exceed fourwithin any calendar years, or all of the work is periormed under contrad with a licensed general building Contractor. -?ttC ,n 8. I understand as an ovvner-Builder if I sell the property for which this permit b bsued, I may be hotd liaue for any finan- cial dr personal injuries sus ained by any subsequent owne(s) that result ftom any htent corlsfucti6n defects in the wortman- ship or materials. #;,;. ,";.] I understand I may obtain more information regardirig my obligations as an 'employef from the lntsmal Revenue Ser- United States Small Busirress Adminisiration, the Califomia Department of Benefrt Payments, and lhe Califomia Divi- sion of lndustrial Accidents. I also understaod I may conlad the Califomia ContracloB' Slate Licens6 Board (CSIB) at 1-800- 321-CSLB (2752) or www.cslb.ca.ooy for nlore inloim.ation about licensed contraclors. 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand lhat I am lhe pa and :*7fl!ible for 5/t t n pfo construct at following ad- dress Z 4 2aA t'-A't't.l agree that, as lhe psrty legally and financially responsibls for th6 proposed construclion acdivity, I will abile by all -appliteble lav/s end requiremenls lnal govem Owner-Builders as well as employers. {Q,r.l agree to notiry the issuer of this form immediately of any additions, deletions, or changes lo any of the information I have proviled on this form. Licensed cootraciors are regulated by laws desoned to pmtect the public. lf you cor rac{ with someone who does nol have a license, the Contraclors' State License Board may be unable to assist you wilh any financial loss you may sustain as a result of a complainl. Your only remedy againsl unlicensed Conlraclors may be in civil court. lt is also important for you to understand thal if an unlicensed Conlrador or employee ofthat indMdual or firm is injured while working on your property, you may be held liable for damages. lf you obtain a permit es Owner-Builder and wish to hire Contactors, you will be responsible for verifying whether or not those Contraclors are pmperly licensed and the slatus of their workers' compensation insurance coverage. Before a building pâ‚¬rmit can be issued, this form must be completed and signed by the property owner and retumed totheagencyresponsiblefo]issuingthepermit.Note: lion. o( dher verilication acco,,,bte to the aoencv ls reault!"d to be oresented when the ,â‚¬rmit is issued to verifv the prooerlY owner's s io natu re, Signature of Property Owner Print name of olflner t/ AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Propâ‚¬rty Oflner, 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 documenls necessary to obtain en Owner-Builder Permit for my proiecl. Scope of Construclion Projed (or Oescription of Work) Poecl Location or Addrâ‚¬ss Name of Aulhorized Agenl Phone Number of Aulhorized Agent: I declare under ponalty of perjury that I 8m the property owner for the address listed above and I pâ‚¬rsonally filled out the above inbrmation and ce ify its accuracy. Property Owner's Signature:Oate: Print Name of Owner: Note: A copy d tthe o,,,nefs ckivels tlcense, fon noartzadon, or d,her wriftcatlon accefubte to the agency is re- quirect to be presentec, when the permit is issued to verify tlrc property a nefs slgnature. aa": .)5-eo- AO Address of Authorized Agenl: