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Home My WebLink About2921 S Daimler St - Misc. PermitMAYOR Mrguel A. Pulido MAYOR PRO TEM SalTinajero COUNCILMEMBERS Angelica AmezcLra P David Eenavides Michele i,4arlinez Roman Reyna Vincenl F Sarmienlo CITY I\,1ANAGER David Cavazos CITY ATTORNEY Sonia R Carvalho CLERK OF THE COUNCIL Maria D HLrizar CITY OF SANTA ANA PLANNINC & BUILDING ACENCY 20 Crvrc Centea Plaza P O. Box 1988 . Santa Ana. Calrlornia 92702 www.5anta-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 at zq, L t Do-l wles g\=.+S"^A^-n L1a-g We are providing you with an Owner-Builder 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 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 ACKNOWLEGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand or verify this information. -d\Vl . t understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" building permat that erroneously implies that the property owner is providing his or her own,abor and material personally. l, as an Owner-Builder, may be held liable and subject to serious financial risk for any inJuries sustajned by an unlicensed person and his or her employees while working on my property. l\4y 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. -pM t understand building permits are not required to be signed by property owners unless they are responsabte for the construction and are not hiring a licensed Contractor to assume this responsibility. M. t 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. M t understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. Nltr'S. t 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. 0WO. t understand if I am considered an "employer" under siate 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 abide by these laws may subiect me to serious financiai risk. LM ,understand under California Contraclors' State License Law, an Owner-Builder who builds singteJamily residential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. financial workma t^\lzd I understand as an Owner-Builder if I sell he property for which this permit is issued, I may be held liable for any lor personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the nship or materials. Mn , understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Servrce, the United 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 (CSLB) al 1-800-321-CSLB (2752)or www.cslb.ca.qov for more information a bout licensed contractors LW)r the'party cpm oensatron insurance coverage. $1B"for" a building permit can be issued, this form must be compt\ returned to the agency responsible for issuing the permit. /Vofe: I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am legally and financially responsible for prop osed construction activitv atM"-the followino address ? fulzll .l agree that, as the party legally and financially responsible for this proposed construction activity, I wil abide by all applicable laws and requirements that govern Owner-Builders as well as employers. $2(Z f agree lo notify the rssuer of this form immediately of any addations, 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 tinancial 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 Owner-Builder and wish to hire Contactors, you wi be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' eted and signed by the property owner and form notarization. or other verification acceDtable to the adencv is reouired to be Dresented when the permit is Signature of Property Owner Gar*u. af:+L f Date /o Print name of Owner frilo 3 Zo,,t H AUTHORIZATION OF AGENT TO ACT ON PROPERW 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. e l.rl,rr<^-\,?,-t'U to the ner's Scope of Construction Project (or Description of Work).rL .),F t, Project Location or Address 21tt l)q,u,Jo. 9+e*,,-ta.nl,o,b,t A-c,<-b4 Name of Authorized Agent 7o [i^- ^J Address of Authorized Agent l{ tf Le<t ^) Phone Number of Authorized Agent ?t\_7.{-) ^ 1;6l I declare under penalty of periu ry that I am the property owner for the address listed above and I personally filled out the above information and certily its accu "&-z^-.-9 AJ---Property Owner's Signature Print Name of Owner: 5 A4lpo,Z 2"/A Note: A copy of lhe owner's drivor's license, form notaization, or other verificaaion acceptable to the agency is required to b6 presented when the permit is issuad to verify tha propsrly owner's signature. PLinkiWP5l/Counter Aclivity/Assembly Eills/Nolice to Property Form 03-13-2014 SANTA ANA CITY COUNCIL M,guerA Pu d( i S.,rnsFo M.yq i VayrPolm Warc6 i vPurdo@sanlE.a.a o.o ; ST'ia'so@3anra-an. o'o i Mmeu@alas&6-ana oo P Ooeo Benaeo6 ii ward r i i O8a&d66sanla-ea d i A coDV of the DroDedv owner's drivet's license, Date: V'rcenl F Samenb vsamenro@sanB-ana o.o