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Home My WebLink About2505 W Strawberry Ln - Misc. PermitIVAYOR lvliguelA. Pulido [,AYOR PRO TEN,4 l\.4ichele l\rartinez COUNCILI\,(EIVBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY MANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carva ho CLERK OF THE COUNCIL l\,4aria D. Huizar CITY OF SANTA ANA PI-ANNING & BUILDING ACENCY 20 Civic Center Plaza P.O. Box I 988 . Santa Ana, California 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 improvements speciried ^:ku- p lw ?- s- os- S+ /_ q. e/ / e ), /.-r' L.,SqV We are providing yo u with an O ent nd 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 cannol execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON SANTA ANA CITY COUNCIL mpul do@sant6-ana oro Mayor Pro Tem. Ward 2 mimanroez@sanla.ana.o.o V cenre Sam enlo vsarmrento@sanla-ana.oro isoloriorAsanla ana.oro dbe.av'des@sanra ana.oro lyi!e!a@sada:a!@ slinaiero@sanla-ana.oro DIRECTIONS: Read and initial each statement below to signify you understand or verity this infomation. O) AU. I understand a lrequent 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 linancial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. N,4y homeowner's insurance may not provide coverage lor 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 property. J2-az. 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. Il4, I understand as an "Owner-Buildel' I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hlring a licensed Contractor and having the permit liled in his or her name instead of my own. 0!-4. , understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and conlracts. J!4 I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value ol my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employea' under state and federal law. { J4u. ,understand ij I am considered an "employer" under state and Federal law, I must register wlth the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation of each "employee." I also understand my Iailure to abide by these laws may subjecl me to serious f inancial risk. {!-q I understand under Calilornia Contractors' State License Law, an Owner-Builder who builds single{amily residential structures cannot legally build them with lhe intent to offer them for sale, unless a//work is performed by licensed subcontractors and the number ol structures does not exceed four within any calendar years, or all of the work is performed under contracl with a licensed general builAing Contraclor. ,2-y, 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 injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or materials. !l g I understand I may obtain more inlormation regarding my obligations as an "employef'Irom the lnternal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the Cafifornia Division ol lndustrial Accidents. I also understand I may contact the California Contractors' State Llcense Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov Ior more information about licensed contractors. TIJ (V tO.l am aware of and consent to an Owner-Builder building permit applied Ior in my name, and understand that I am the party address: legaliy and finan ly res onsible fo propo sed cons uction activ Ity at the f ollo wrng )__Ltt.l agree that. as the party legally and f inancially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. ]_&f Z. I agree to notify the issuer of this lorm immediately of any additions, deletions, or changes to any of the information I have provided on this f orm. Licensed contractors are regulaled 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 verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Belore a building permit can be issued, this torm must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. A/ote.' A coDv ot the DroDertv owner's driver's license. form notarization, or other cation acceDtable to the aoencv is reouired to be ted when the permit is Signature of Property Owner Date f/0,/rq Print name ot Owner r |E= cl-S D, nz- t'/ o g@r' eJ rq AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution ol which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply 1or, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work) Project Location or Address Name of Authorized Agent Address of Authorized Agenl: Phone Number ol Authorized Agent ldeclare 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 Owneis Signature Date Note: A copy ot 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 verify the properly owner's signature. SANTA ANA C TY COUNC]L mo! l do@sanla'ana oro rMayo. Pro lem, Ward 2 mma4rne?@saoG:a!a.a& V cenre Sarmie.lo vsamrenlo@sanra-ana.oro 6olono@sanra ana oro P. Dav d Benavides dbenavrdes@santa ana.orc Nilleoas@santa a.a oro slrnaiero(asanla ana.oro issued to verifv the proDertv owner's sionature. Prinl Name of Owner: