HomeMy WebLinkAbout2506 N Linwood St - Misc. PermitI\,,IAYOR
l\.4iguel A. Pulido
IVAYOR PRO TEIV
Michele l\.4artinez
COUNCILI\,1EI\,48E RS
P. David Benavides
Vicente Sarmiento
Jose Solorio
SalTinajero
Juan Vi legas
CITY MANAGER
Raul Godinez ll
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
Maria D. Huizar
CITY OF SANTA ANA
PLANNING & BUILDING AGENCY
20 Civic Center Plaza
P.O. Box 1988 . Santa Ana, California 92702
www.santa-ana.or9' pba
NOTICE TO PROPERTY OWNER
Dear Property Owner
An application for a building permit has been submitted in your name listing yoursell as the builder of the property
i{4:rovements specif ied at
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We are providing you with an OwnerBuilder Acknowledoment 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 ol each provision, signed, and returned
this lorm to us at our ollicial address indicated. An agent of lhe owner cannot execute lhis notice unless you, the property
owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VEBIFICATION OF INFORMATON
DIRECTIONS: Read and initial each statement below to signify you understand or verity this information.
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1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder"
g permit that erroneously implies that the property owner is providing his or her own labor and material personally. l,
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 lor sale, unless ail work is performed by
as an Owner-Builder, may be held liable and subject to serious linancial risk lor any injuries sustained by an unlicensed
person and his or her employees while working on my property. lr/y homeownefs insurance may not provide coverage lor
those injuries. I am willlully acting as an Owner-Builder and am aware ol the limits of my insurance coverage for injuries to
workers on my propeny.
lWz. I understand building permits are not required to be signed by property owners unless they are responsible tor
the construction and are not hiring a licensed Contractor to assume this responsibility.
M-r. t understand as an "Owner-Bullder" I am the responsible party of record on the permit. I understand that I may
pr6lect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name
instead ol my own.
l4-0. , understand Contraclors are required by law to be licensed and bonded in Calilornia and to list their license
numbers on permits and conlracts.
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I A ) 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the
total value of my construction is at least live hundred dollars ($500), including labor and materials, I may be considered an
''%rployea under state and federal law.
lK U. tunderstand it I am considered an "employea' under state and Federal law, I must register with the state and
fede"ral government, withhold payroll taxes, provide workers' compensatlon 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 Iinancial risk.k
m.Uido@sanla'ana.o.o
M chele lranroez
[,,layor Pro Tem, Ward 2
mimanine2@santa.ana.oro
V cente Sarm ento
vsarm ento@santa-ana.o.o isolqi!@alla:alal4 dbonavldes@sanlaana.oro ivilleoas@santaanaoro srnaie.o@sanra.ana.oro
SANTA ANA CITY COUNCIL
licensed subcontractors and the number of slructures does not exceed lour \i/ithin any calendar years, or all of the work is
pe rformed under contract with a licensed general building Contrictor. -
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
fin cial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the
workmanshio or materials-
l*fg. I understand I may obtain more information regarding my obligalions as an "employea'from the lnternal Revenue
Se#ce, the Uniled States Small Business Administration, the California Department of Benefit Payments, and the
California Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board
B) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors
10. I am aware of and consent to an OwnerBuilder building permit applied for in my name, and understand that I am
the part leg ally and f inan all responsible lor proposed constructio n tiv iJ)/ at the lollowing
address I a
1'1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by
a applicable laws and requirements that govern Owner-Builders as well as employers
'12. I agree to notif y the issuer of this lorm immediately of any additions, deletions, or changes to any of the
ormation I have provided on this lorm
Licensed contractors are regulated by laws designed to protect the public. lt you contract with someone who does not
have a license, the Contractors' State Licensg 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 ol 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 responsfble for issuing the permit. Nore.' A copv of the propertv owner's driver's license.
form nz,tion to the ,s uired to
Signature of Property Ow
Print name of Owner ,'
ner Date c /z //4
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
iollowing person(s) to act as my agent(s) to apply for, sign, and flle the documents necessary to obtain an Owner-Bu lder Permit for my
project.
Scope of Construction Projecl (or Description of Work)
Project Location or Address
Name oi Authorized Agent
Address ol Authorized Agent
Phone Number of Aulhorized Agent
I declare under penalty of perjury that I am the property owner ior the address listed above and I personally filled out the above
in,ormation and certify its accuracy.
DateProperty Owner's Signature:
Print Name ol Ownet:
Note: A copy ol the owner's *iver's ticense, torn rct te to the agency is requlred to
be presented when the permit is issued to vetify the prcperty owner's signature.
,:,irf \'/:'5' 1,.!riiA..!,ti A:sr.Li rliii ii.:r. i. P ^tjri ir; d:: a: r. ;i,r
SANTA ANA CIIY COUNCIL
l,lrgue A Puhdo Mrchelellaa]neu Vcentesamenro Jose Solorlo P. Davd Beoavdes Juanvlllegas SalTriajero
Mayor l,layor Pro Tem, Ward 2 ward 1 Ward 3 Ward 4 Ward 5 Ward 6