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Home My WebLink About2217 S Salta St - Misc. PermitMAYOR Miguel A. Pulido I\,,IAYOR PRO TEM Michele N,4adinez COUNCILMEMBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinalero Juan Villegas CIry N'ANAGER Raul Godinez ll CIry ATTORNEY Sonia R. Carialho CLERK OF TIiE COUNCIL Maria D. Huizar CITY OF SANTA ANA PLANNING & BUILDING AGENCY 20 Civic Center Plaza P,O, Box 1988 . Santa Ana, California 92702 www.sanra-ana,or9 pba NOTICE TO PROPERTY OWNER Dear Property Owner na fo tn permit h een s bmitted in ur am rng u rself th er ol the property rmp S cif ied We are providing you with an Owner-Builder Acknowledqment and lnformation Verlfication 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 oflicial address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of lhe permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON E S: Read and initial each statement below to signify you understand or verify this intormation. 1. I understand a frequent practice ol unlicensed persons is to have the propeny 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 OwnerBuilder, may be held liable and subject to serious financial risk for any in.iuries sustained by an unlicensed person and his or her employees while working on my property. lr/y homeownels insurance may not provide coverage lor ilder and am aware of the limits of my insurance coverage for injuries to ired to be signed by property owners unless they are responsible for actor to assume this responsibility. he responsible party of record on the permit. I understand that I may rotect myself from potential Iinancial risk by hiring a licensed Contractor and having the permit Iiled in his or her name S tead o ll ^ f my own. I understand Contractors are required by law to be licensed and bonded in California and to list their license ers on permits and contracts 5. I understand if lem ploy or otherwise engage any persons, other than California licensed Contractors, and the tal value of my construction is at least live hundred dollars ($500), including labor and materials, I may be considered an r" under state and lederal law I understand if I am considered an "employea' 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 qnemployment compensation ol each "employee." I also understand my failure to abide by these laws may subject me to /gerioug f inancial risk. ,{Q !', I understand under California Contractors' State License Law, an owner-Builder who builds singleJamily residential struclures cannot legally build them with the intent to ofler them for sale, unless a// work is performed by SANTA ANA CITY COUNCIL atio m fio! I do@santa-ana.oro Mayor Pro Tem, Ward 2 mrman nez@sanla-ana.oro Vrcente Sarmienb vsa.mienlo@sanla.ana.oro isolorio@santa.ana.oro dbenavdes@sanla ana oro iv lleoas@sante ana oro slnaiero@sanE ana oro on my property. nsed subcontractors and the number of structures does not exceed lour within any calendar years, or all of the work is ormed under contract with a licensed general buildi /1 //8. I understand as an Owner-Builder if I sell the ng Contraclor. property for which this permit is issued, I may be held liable for any fl ancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction delects in the rkmanship or materials 9. I understand I may obtain more information regarding my obligations as an "employea'from the lnterna! Revenue rvice, the United States Small Business Administration, the California Department of Benefit Payments, and the Division of lndustrial Accidents. I also understand I may contact lhe Calitornia Contractors' State License Board 1-800-321-CSLB (2752) or www.cslb.ca.oov f or more information about licensed contractors I am aware of and consent to an Owner-Builder building permil applied tor in my name, and understand that I am egally and financially responsible for proposed constructlon activity at the following 1. I agree that, as the party legally and financially responsible lor this proposed construction activity, I will abide by icable laws and requirements that govern Owner-Builders as well as employers. 2. 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 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 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 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 verilying 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 responsibl e r issuing th it. /Vote.' A copv of the propertv owner's driver's license, torm notarization or other veri wh issued to the o Signature of Property Date 5-e> -a0/7 Print name of Owner Onzct,q 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 acl as my agent(s) to apply for, sign, and file the documenls necessary to obtain an Owner-Builder Permit for my project. Phone Number ol Authorized Agent ldeclare under penalty ot periury that I am the property owner for the address listed above and I personally filled out the above inrormation and certily its accuracy. Properly Owneas Signature Date Print Name of Owner Note: A copy ot the owner's driver's license, torm notarization, ot other verilication acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. ) . !-r .: t.!.,r, n..1,,.ir..,,r,r.f: SANTA ANA CITY COUNCIL ss natu mouldo@sanla ana oro [,layor Pro T6m, Ward 2 m man nez@sanra ana.oro V cente Sa.mre,rto vsarmie.to@santa-ana.oro 6oloro@sanla-an6 oro ScopeolconStructionProject(orDescriptionoIWork): Proiect Location or Address: Name of Authorized Agent: Address of Authorized Agent: P David Beravides Juan Villeqas Sal Trnalero Ward 4 Ward 5 Ward 6 dbenavdes@sanraa.a.oro jyine$s@sada:a!@ slnaiero@sanla-anaoro