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Home My WebLink About2652 N Oakmont Ave - Misc. PermitMAYOR Miguel A. Pulido MAYOR PRO TEM [,4ichele Martinez COUNCILMEMBERS P. Oavid Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY MANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar CITY OF SANTA ANA PLANNINC & BUILDING AGENCY 20 Civic center Plaza P.O. Box I 988 . Santa Ana, Califomia 92702 www.santa-ana.org / pba NOTICE TO PROPERW OWNER Dear Property Owner An application for a building permit has been improvements specified ., 2bSL SU bmitted in vour name listinq vourself as the builder of the property ay':nao'nl Strt^,\r.^ qzlot We are providing you with an your responsibilities and poss -Builder Acknowle e ln rmation Verification For to make you aware of ible 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 ACKNOW LEDGMENT AND VERIFICATION OF INFORMATON DTRECTIONS: Read and initial each statement below lo signify you understand or veri fy this information. 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" uilding p ermit that erroneously implies that the property owner is providing his or her own labor and material personally. l, as an Ow ner-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 workers on my property. 2. I understand building permits are not required to be signed by property owners unless they are responsible for construction and are not hiring a licensed Contractor to assume this responsibility 3. I understand as an "Owner-Builder' I am the responsible party of record on the permit. I understand that I may otect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name nstead of my own 4. I understand Contractors are required by law to be licensed and bonded in California and to list their license umbers on permits a nd contracts 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the tal value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "em oyer" under state and federal law eral . I understand if I am considered an "employer' under state and Federal law, I must register with the state and government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to oyment compensation of each "employee.'' I also understand my failure to abide by these laws may subject me tounempl serious financial risk 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family sidential structures cannot legally build them with the intent to offer them for sale, unless a// work is pe rformed by SANTA ANA CITY COUNCIL moulidoOsanta-ana oro Mayor Pro Tem wa.d 2 m man ne2@sanla?n6.oro vice.re Sar.nienlo vsarmienloaasanla-ana oro so orloaAsanta ana.oro P Oavid Seoavrdes dbenav des@saola ans.oro ivilleoas@santa-ana.oro sli.a ero@sanIa ana.oro licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is pe ed under contract with a licensed general building Contractor. . I understand as an Owner-Builder if I sell the property for wh I or personal iniuries sustained by any subsequent owne(s) th 8 ich this permit is issued, I may be held liable for any tna cra at result from any latent construction defects in the wor manship or materials 9. lunderstand lma y obtain more information regarding my obligations as an "employer" from the lnternal Revenue C ervice, the United States Small Business Administration, the California Department of Benefit Payments, and the alifornia Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board ) at 1-800-321-CSLB (27 52) or www.cslb.ca.qov for more information about licensed contractors 0. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am L e party legally and financially responsible for proposed constructimoh+ a,rrwla tnz\ on activitv at the followinoqzlo<ad ress: AGe ?- p pli 1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by cable laws and requirements that govern Owner-Bullders as well as employers. 2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the ormation 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 as 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' compensalion 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 permit. ,Vote.. form notarizatio n or other verification acceDtable to the aqencv is reouired to be nresen ted when the Dermit is ,ss the o Signature of Property Print name of Owner Date 4-t>tq e-G t'l rve.ros 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 file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work)tca 1.9 ^[r ( Project Location or Address 00'{a66'n|&.a ltnos Name of Authorized Agent: Address of Authorized Age rcn ,ll n,7(tSL Atul o /l+Srrritr A qZTE Phone Number of Authorized Agent -1t+1Ll3-t271 I declare under penalty of perjury lamthep ner for the address listed above and I personally filled out the above information and certify its accurac l^[-x)-tL1qProperty Owner's Signature Date Print Name of Owner:v{-r Nole: A copy of the owner's s license, form notarizalion, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the propefly owner's signature SANTA ANA CITY COUNCIL mou do@santa-a.a oro Mayo. P.oTem Ward 2 mimarl nez@sanra ana.o.o Vrcenie Sarmienlo vsarm ento@sanla-ana.oro so or o@sarla-ana oro P Dav'd Aen.vdes dbe.avdes@santa-ana oro rvilleoas@santa'ana!!q slimie.o@santa-a.a oro A copv of the DroDertv owner's driver's license.