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HomeMy WebLinkAbout2237 S Kilson Dr - Misc. PermitI\4AYOR lvliguel A. Pulido MAYOR PRO TEM Michele Martinez COUNCILI\,lEIVBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY MANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar CITY OF SANTA ANA PLANNINC & BUILDING AGENCY 20 Civic Center Plaza P.O. 8ox 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 yourself as the builder of the property improvements specified at A.270'7r We are providing you with an Owner-Builder Acknowledqment and lnformation Verification Form to make you aware of your responsibiliiies 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 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 VERIFI CATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understa nd or verify this information. L@: I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" Effiing permit that erroneously implies that the property owner is providing his or her own labor and material personally. l, as an Owner-Bullder, 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. My 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 on my property 2. I understand building permits are not required to be signed by property owners unless they are responsible for nstruction and are not hiring a licensed Contractor to assume this responsibility 3. lunderstand as an "Owner-Buildei' I am the responsible party of record onthe permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instpad of my own. ILO I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. Efu_5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the -io-tal value of my construction is at least five hundred doltars ($500), including labor and materials, I may be considered an ployer" under state and federal law the e 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 wo unemployment compensation of each "employee." I al rkers' compensation disability insurance, and contribute to so understand my failure to abide by these laws may subject me to SE us financial risk reside 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family ntial structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by SANTA ANA CITY COUNCIL moulido@sanl8-ana oro Mayor Pro Tem, Ward 2 mimaninez@sanla-ana.o.o vsarm e.to@santa -a na.oro solodo@saiia ans.oro P. Davd Benavdes dbenavides@sanla-a.a.o.o ivilleoas@santa-ana.oro stina1610@sa.ta-ana oro licensed subcontractors and the number of structures does not exceeo four within any calendar years, or all of the work is pe ed under contract with a licensed general building Contractor 8. I 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 in,uries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. /h-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 Benefit Payments, and the California Division of lndustrial Accldents. I also understand I may contact the California Contractors' State License Board (CSIB) at 1-800-321 -CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors. 223 ,, I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by a plicable laws and requirements that govern Owner-Builders as well as employers 12. I agree to notify the issuer of this form 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 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' com pensation insurance coverage. form or other veri na able to the ,s ired to be s n to the s ture Signature of Property Owner Date 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 ,ollowing person(s) to act as my agent(s) to apply for, sign, and flle the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work)eh^ Project Location or Address Name of Authorized Agent Address of Authorized Agent: Phone Number of 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 informalion and certify its accuracy. Property Owner's Signature Date Print Name of Owner: Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to yerify the property owner's signature. SANTA ANA C]TY COUNCIL mDUlldorAsanlB a.a oro Mayor Pro Tem Ward 2 m man nez@sanla-ana.o.o vsarmie.l0@sanla ana oro rso oro@sania ana.oro 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. Note: A copv of the prooertv owner's driver's license. Print name of Owner P Oavid Beoavdes Joa. Vrllegas Sal I naierc \Nafi 4 Ward 5 Ward 6 dbenavldes@sanla-a.aorc lvilleoas@santa-anaoro slinaiero@sanIa-anaoro