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Home My WebLink About2304 W Saint Anne Pl - Misc. PermitPlanning & Building Agency Building Safety Division 20 Civic C6nter Plaza P.o. Box 1988 (M-19) Santa Ana, cA 92702 (7141 647 -5800 www.santa-ana.org APP-13 CBC 2015 NOTICE TO PROPERW OWNER Dear Property Owner: An application ro perm bee UT listin o rS s the er e prop imorovem ents specified at We are providing you with an Owner-Builder Acknowledqment and lnformation Veriflcation Form /,A- q 2 toWa(e you aWare of tu vo!?- 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 ACKNOWLEGMENT AND VERIFICATION OF INFORMATON DIRECTrcNS: R6ad and initial sach statement below to signify you understand or verify this infomation. V lt{ rndur.,and a frequent practice of unlicensed persons is to have the property owner obtain an 'Owner-Builded' build- ing permit that erroneously 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 subject 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 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 prop- erty. V*, I understand building permits are not required to be signed by property owners unless they are responsable for the construction and are not hiring a licensed Contractor to assume this responsibility. V3 tunderstand as an 'Owner-Builded' I am the responsible party of record on the permit. I understand that I may protect myseif from potential financial risk by hiring a licensed Contractor and having the permit liled in his or her name instead of my own. Ya.Vrro.*,and Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. VMrunderstand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least flve hundred dollars ($500), including labor and materaals, I may be considered an 'employe/' under state and federal law.VIJ 6. Iunderstand if Iam considered an "employer" under state and Federal law, Imust register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment com- pensation of each'employee.' I also understand my failure to abide by these laws may subject me to serious financial risk. Vj ,understand under California Contractors' State License La!v, an Owner-Builder who builds singleJamily residential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by licensed subcontrac- tors and the number of structures does not exceed four within any calendar years, or all of the work is performed under contracl with a licensed general building Contractor. V-N t understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any finan- ^lal ol personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman- '. aterials. responsibilities and possible risk you may incur by having this permit issued in your names as the Owner-Builder. V l{ vice, the sion of ln 321-CSL I understand I may obtain more information regarding my obligations as an'employer" from the lnternal Revenue Ser- United States Small Business Administration, the California Department of Benefit irayments, and the california Divi- dushial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-g0O- B (2752) or wu,rr. cs lb.ca.qov for more information about licensed contractors. V-14 I am aware of and consent to an Owner-Builder building permit applied for in my name and understand that l?m the ly and financially responsible for proposed construction activity at the following ad-party legal d ress: VJU l.agree that, as the party legally and fjnancially responsible for this proposed construction activity, I wilt abide by all applic'able laws and requirements that govern Owner-Builders as well as employers. \J--L1? I agree to notfy the issuer of this form immediately of any additions, deletions, or changes to any of the information Ir.lfavf/rovided on this form. Ljcensed 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 ior you to understand that lf 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 wtlioe rispbnsiot6 for veifying whether or not those Conlractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form mu to the agency responsible for issuing the permit, rr/o st be completed and signed by the property owner and returned te:A coDv of the Drooertv ow ner's driver's license. fo rm notariza- tion or other table /s u e \ignature of Property Owner Date: October 9,2019 rint name of Owner Vicky Nguyen AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice the following person( Permit for my prolect to Property Owner, the execution of whic s) to act as rry agent(s) to apply for, sign, h I unde my personal responsibility, I hereby authorize ments necessary to obtain an Owner-Builderethe docu Scope of Construction Project (or Descriptjon of Work) Project Location or Address lVJ f,a/yut'e,q fuv dru/(,ame of Authorized Agent Thanh Hieu Nguyen Address of Authorized Agent N CI o t/2 LA 0)0 / Phone Number of Authorized Agent I declare under penalty of perjury th information and certify its accuracy. at I am the property owner for the address listed above and I personally filled out the above Print Name of Owner:Vicky Nguyen Note: A coPy of the owner's driver's license, form notarization, or other veification acceptable to the agency is te-qulred to be ptesented when the permit is issued to verv the prope,ty ownels signature. proDeftv owner's sidnatu re. /)(./ _) (rrop"n, Ownels Signaturei Date October 9. 20]9