HomeMy WebLinkAbout2506 W Stanford St - Misc. PermitMAYOR
MiguelA. Pulido
MAYOR PRO TEI\,4
lvlichele Martinez
COUNCILMEMBERS
P. David Benavides
Vicente Sarmiento
Jose Solorio
SalTinajero
Juan Villegas
CITY MANAGER
Raul Godinez ll
CITY ATTORNEY
Sonia R. Carvalho
CLERK OF THE COUNCIL
l\,4a.ia D. Huizar
CITY OF SANTA ANA
PLANNINC & BUILDING ACENCY
20 Civic Center Plaza
P.O. Box 1988 . Santa Ana, Cal fornia 92702
www.santa ana.org pba
NOTICE TO PROPERry OWNER
6[An applicati fo b rmt sbe submi tn ur na ting lf as e UI ero e v
improvements ec
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 to signify you understand or verify this information.
&f-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 OwnerBuilder, 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
workers on my property.
;l.L.Z. I understand building permits are not required to be signed by property owners unless theyare responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
-t.4. 3. I understand as an "Owner-Builder" I am the responsible party of record on the 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
instead of my own.
J'f , q. I understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
J--e_s. 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 five hundred dollars ($500), including labor and materials, I may be considered an
"employer" under state and federal law.
.t-LA. 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 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.
I f I I understand under California Contractors' State License Law, an Owner-Builder who builds single-famity
residential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by
SANTA ANA CITY COUNCIL
mo!lidolOsanta-ana oro
Mayor Pro Tem. Ward 2
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Dear Property Owner:
I
licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is
pe '.)rmed under contract with a licensed general building Contractor..t.f 1! A. t 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.
t-Lg. t understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue
Service, the United States Small Business Administratlon, 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
(CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors.
J-L-10.1 am aware of and consent to an OwnerBuilder building permit applied for in my name, and understand that I am
the party Iegally and financially responsible for proposed construction activity at the following
ad dress:
J-/i ll.I agree that, as the party legally and financially responsible for this proposed constructjon activity, lwill abide by
all applicable laws and requirements that govern Owner-Builders as well as employers.
,'t /: 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information 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 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.
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 p ermit. /Vote: A coDv of the DroDertv own er's driver's license.
form notarization. or o ther verification acceptable to the aqencv is required to be D resented when the permit is
Signature of Property Owner Dale: C-/ ,r/ f q /le7
Print name of Owner
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 flle the documents necessary to obtain an Owner-Builder Permit for my
project.
Scope of Construction Project (or Description of Work)
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.
Date
Print Name of Owner:
Note: A copy of the owner's driver's license, torm notarization, or other verification acceptable lo the agency is required to
be presented when the permit is issued to verify the properly owner's signature., , r: i i . ,:rr. -.r...! ....,-i .ri, i "r -. I tl
SANTA ANA CITY COUNC L
moulido@,sanra ana.ro
[,layor P.o Tem, Wa.d 2
mimarllnez@sanra ana oro
V,ce.re Sarm e.ro
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P Da? d Be.av des
dbenavdes@sanla'a.a oro slrnarerolasanta-ana.orov eoas@sania a.a oro
issued to verifv the propertv owner's signature.
Project Locahon or Address:
Phone Number of Authorized Agent:
Property Owner's Signature: