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Home My WebLink About2360 N Riverside Dr - Misc. PermitT,lAYOR Miguel A. Pulido I\,4AYOR PRO TEM lvlichele Martinez COUNCILI\,lEMBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY OF SANTA ANA PLANNINC & BUILDING AGENCY 20 Civic Center Plaza P.O. Box 1988 . Santa Ana, Calafornia 92702 www.santa-ana.org/pba 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 CITY IMANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar rovements s Sa C+ lztov We are providing you with an Owner-Builder Acknowledqment and lnformation Verification 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 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 VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below lo signify you understand or verify this information. /'AINlj_v 1 I understand a frequent practice of unlicensed persons is to have the property 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 Owner-Builder, 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 buildin g permits are not required to be signed by property owners unless they are responsible for th nstruction and are not hiring a licensed Contractor to assume this responsibility I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may ect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name adofm y own lmP oecified at' nJ. ({,Ye-rsi& }r,v< I understand Contractors are required by law to be licensed and bonded in California and to list their license rs on permits and contracts S en tia I understand under California Contractors' State License Law, an Owner-Builder who builds single-family structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by SANTA ANA CITY COUNCIL moulido@santa-ana.oro Mayor Pro Tem Ward 2 m marl ne2@sanla'a.a ora vsarm ento@sanla ana oro P Oav d Benavdes dbenavidesrOsanra-ana.oro iv eoas@santa-ana oro srinaero@santa ana.oro A-^-- ([[l\ I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the tp\l value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an,dnlqloyei under state and federal law. 4[Vi, understand if I am considered an "employer" under state and Federat taw, I must register with the state and feft)ral government, withhold payroll taxes, provide workers' com pensation disability insurance, and contribute to unemployment compensation of each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. isolo o@santa-ana,oro licensed subcontractors and the number of structures docs not exceed four within any calendar years, or all of the work is pe ed under contract with a licensed general building Contrector ncial I understand as an Owner-Builder if I sell the property for whlch this permit is issued, I may be held liable for any or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the anship or materials I understand I may obtain more information regarding my obligations as an "employef'from the lnternal Revenue rvice, the United States Small Business Administration, the California Department of Benefit Payments, and the lifornia Division of lndustrial Accidents. I also understand I may contact the California Conlractors' State License Board (c ) at 1-800-321 -CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am party I llv and L' financ yre onsible fo1 sed construction activ ity at the following agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by al plicable laws and requirements that govern Owner-Builders as well as employers I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the ation 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' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsibf e for issuing the pcrmit. /Vofe.' A copv of the propeftv owner's driver's license. form notarization. or other verifica tion acceDtable to the aoencv is reouired to be Dresented when the permit is the owner's Signature of Property Ow Date +\1 Print name of Owner l'^AV]/1.AY), POect Location or Address Name of Authorized Agent Address 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 information and certify its accuracy. Property Owner's Signature Date: Print Name of Owner Note: A copy of the owner's diver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permil is issued to verify the propedy owner's signature. P nr ,/.lpa,r il.u.i0A.1!.1yrA3.cnl-. lil s,NolL.. r. pr.p."1! riE i,:l i4 :1415 SANTA ANA CITY COUNCIL mpu do@sanla ana oro Mayor Prc Ten ward 2 mimadi.ez@sanla-ana oro vsarmrenlo@sanla-a.a oro isoloio@saiia-ana.oro P Oavid Benavdes dbenavidss@sanla-an..oro iv eoaslOsanla-a.a oro stina ero@sanla-ana.oro 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 act as my agent(s) to apply for, sign, and Ille the documents necessary to obtain an Owner-Builder Permit for my project. ScopeofconStrUctionProject(orDeScriptionofWork): \q 5 Phone Number of Authonzed Agent: