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Home My WebLink About2825 Dayna St - Misc. PermitMAYOR Miguel A. Pulido MAYOR PRO TEM Michele Martinez COUNCILMEIUBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY OF SANTA ANA PLANNING & BUILDING AGENCY 20 Civic Center Plaza P.o. Box 1988 . Santa Ana, Californaa 92702 www.santa-ana.org / pba NOTICE TO PROPERTY OWNER Dear Property Owner: An appllcation for a building permlt has been submitted in your name listing yourself as the builder of the property improvemenlsspecifiedut ,LlL.> la,{ana 5t. 5anh ftn^ - We are providing you wilh an Owner-Builder Acknowledqment and Inlormation Verilication Form to make you aware of your responsibllities and possible risk you may incur by having this permit issued in your names as the OwnerBuilder. 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 signity you understand or verify this information, Cll- ,1 . f understand a frequent practice of unlicensed persons is to have the property owner obtain an "OwnerBuilder" 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 lor 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 lnsurance coverage for injuries to workers on my property. \rli- z. f understand building permits are nol required to be signed by property owners unless they are responsible lor the conslruction and are not hiring a licensed Contractor to assume this responsibility. \,^L 3. I understand as an "Owner-Buildei' I am the responsible party of record on the permit. I understand that I may protect myself from potential linancial risk by hiring a licensed Coniracior and having the permit filed in his or her name instead of my own. \)[* +. f understand Contractors are required by law to be licensed and bonded in California and to list their license ntL'plers on permits and contracts. U[- u ' understand if I employ or otherwise engage any persons, other than Calilornia licensed Contractors, and the total value of my conslruction is at least five hundred dollars ($500), including labor and materials, I may be considered an "emyloyel' under state and federal law. tt ,l-+. t understand if I am considered an "employer" under state and Federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation of each "employee." I also understand my failure to ablde by these laws may subject me to serious financial risk. L-'$.- r. f understand under California Conlractors' State License Law, an Owner-Builder who builds singlejamily residentiat structures cannot legally build them with the intent to ofler them lor sale, unless a//work is performed by SANTA ANA CITY COUNCIL CITY I,IANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar mouldo@s.nta-.na oro lvayor Pro Tem, Ward 2 m manLnez@sanla.ana.oro Vicenre Sarmierlo vsamEnlo@sanla-ana.oro isoloio@snta-ana or. P. Oavid Benavides dbenavdes@enta-ana.oro i!iX9!rs@!ada:a!t.!!!sl naiero@santa-ana.oro 'licensed subcontractors and the number ol structures does not exceed four within any calendar years, or all of the work is .performed under contract with a licensed general building Contractor. nl' \lF A. I understand as an Owner-Builder if I sell the property lor which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent conslruction defects in the wo,lmanship or materials. [] g. f understand I may obtain more information regarding my obligations as an "employer" f rom the lnternal Bevenue 'Service, the United States Small Business Administration, the California Department oJ Benelit Payments, and the Californla Dlvision of lndustrial Accidents. I also understand I may contact the Calilornia Contractors' Slate License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. ^'t(Uo' 10. I am aware ot and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and fi n iall res nsible for.Drq ed nstru ion activity at the following address:7 iu d\- TE 11. I agree that, as the party legally and financrally responsible for this proposed construction activity, I will abide by all appljcable laws and requirements that govern Owner-Builders as well as employers. -Ltr\2. f agree lo notify the issuer of this form immediately of any additions, deletions, or changes to any oI the inlormation 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 il an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable lor 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 lorm must be completed and signed by the property owner and returned to the agency responsible lor issuing the permit. Nofe.'Aco DV of the DroDertv owner 's tlriver's liaense- n r cation to the ted when the il ls ssi natu lr?Signature of Property Owner Date 9 \b Print name of Owner Clrzfrc L Ia..to Y{<--, AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice lo 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 11le the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construclion Project (or Description of Work) Proiect Location or Address Name of Authorized Agent Address of Authorized Aqent Phone Number 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 ol the owner's driver's license, form notarization, or other verilication acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature- ,: r \f i,: r i...r',. ;i.. : \ ir ii :.i, r,ar ili ",., -( SANTA ANA CIIY COUNCIL mpulrdo@santa.ana.oro lvlayor Pro Tem, Ward 2 m marlrnez@sanla.ana oro Vi.enre sarm enro vsarmrenlo@sanla.ana.o.o isolono@sa.1a ana oro P. Davd Benav des dbenavdes@sanla ana.oro ivilleoas@sanla-ana.o.o !!-!aie!!@sa4a:!.!.a LWNpro