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Home My WebLink About2125 N Arden St - Misc. PermitPlannlng & Bullding Agency Bulldlng Safety Dlvlslon 20 Civic Center Plaza P.O. Box 1988 (M-19) Santa Ana, CA 92702 17141647-5800 www'santa-ana.org APP.13 GBC 20,t6 iF-:: Dear Property Owner: An applicatio a buildi ng pe rmit has been submitted in NOTICE TO PROPERTY OWNER ur name listin s fasth e byldet of4'<12-tfl--)>-'.perty improvements specified at We are prov ding you wlth an Owner-Builder Acknowledoment and lnformation 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 Owner-Builder. We will not issue a building permil untjl you have read, initialed your understanding of each provision, signed, and returned this form to us at our officlal address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permltting authority. OWNER'S ACKNOWLEGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and lnltial each statement below to slgnlfy you undorstand or verify thls informatlon. W-1 I understand a frequent practice of unlicensed persons is to have the propâ‚¬rty owner oblain an "Owner-Builder" build- ing permit that enoneously 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 subjed to serious flnancial risk for 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 ,or 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 prop- erty. A-r. 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. -ff.1_3 I understand as an "Owner-Builder" lam the responsible party of record on the permit. I understand that I rnay protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed jn his or her name instead of my own. $Lq I understand Contractors are required by law to be licensed and bonded in Californla and to list their license numbers on permits and contracts. 'W S. I understand if I employ or othemise engage any persons, other than California licensed Contmctors, and the total value of my construction is at least flve hu ndred dollars ($500) including labor and materials, I may be mnsidered an "employef' under state and federal law. /1 /-bl_6 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 unemploymBnt com- pensation of each'employee." I also undershnd my lailure to abide by these laws may subject me to serious flnancial risk.fit1-Z_-7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build thom with lhe intent to offer them for sale, unless a// work ls performed by licensed subconfac- tors and the number of structures does not exceed four within any calendar years, or all of the work is performed und6r contract with a licensed general building Contractor, .Bl--9. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any finan- cial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman- ship or materials. I Att I-kl-g lunderstand I may obtain more information regarding my obligations as an "employe/ from tho lnternal Revenuo Ser- vice, the United Stales Small Business Administration, the Callfornia Department of Benefit Payments, and the Callfomia Divi- sion of lndustrial Accidents. I also understand I may contact the California Conhactors' State License Board (CSLB) at 1-B0o- 321-CSLB (2752) or www.cslb.ca.qov for more information about licensad contractors. 10. I am aware of and consent to an Owner-Builder building permit applied for in my namo, and understand that I am thepartyleoallv and.2-(-z = financially rosponsible for propos ed construction activ at the followin g ad-ity dress ,A*Z-EE{ =[.-5.-<r\t 11. I agree that, as the party legally and financially responsible for this proposed construction activity, lwill abide by all applicable laws and requirements that govern Owner-Builders as well as employers Ar -.J12. lagree to notlfy the issuer of this form immediately of any additions, deletions, or changes to any of the informalion I have provided on thls 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' Stato 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 civil court, lt is also important for you to understand that if an unlicensed Contractor or employee of that individual or flrm is injursd while working on your property, you may be held liable for damages. lf you obtaln a permit as Owner-Builder and wlsh to hiro Contactors, you will be responsible for vaiifying whether or not thos6 Contractors are properly licensed and the status of their workers' compensation insurance covsrage. Bofore a bulldlng permit can bs is6ued, this form must bs complotod and slgned by the property owner and returned to the agoncy re6ponsiblo for issuin the pe rmit, tVofe; A coDv of ths Dropertv owner's drlver's license. fo notariza- o oroDerlv own er's siqnature Signature of Property Owner oate: 12 'o-2- ' | 1 Print name of own ", &4 r/ vLca AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notlce to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorjze the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obhin an Owrier-Bullder Permit for my prgect, Scope of Conskuction Project (or Descnption of Work)Oe- Proj ect Location or Add *"",424 AGzI:r! ->-r--g*r1A Atre,.)o Name of Authorized Agent: Address of Authorized Agent: Phone Number of Authorized Agent:1tA',t=4-'zbt, ldeclare under penalty of perjury I am the property owner for the ddress listed above and I personally lllled out he above information and certify its accu Property Owner's Sig nature l-'t *r* Date: ' r u/--rq \./ 1 Note: A copy ol the owner's drlver's llcense, form notarization, or othor verlficatlon accâ‚¬ptable to th6 agency ts re- quired to be presented when the permlt ls lssued to verlly the property owner's slgnature, Print Name of Owner: