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Home My WebLink About407 W Santa Clara Ave - Misc. PermitI\,IAYOR MiguelA. Pulido MAYOR PRO TEI\,I Michele Martinez COUNCILME[,4BERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY OF SANTA ANA PLANNINC & BUILDINC ACENCY 20 Civic Center Plaza P.O. Box I988 . Santa Ana, California 92702 www.santa-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 ol the property improvementsspeciriedut go1 lf .Sa*r-'r ClecA Aur.<rr,rtt Ava C h !'ltb 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 OwnerBuilder. We will not issue a building permit until you have read, initialed your understanding ol 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: Bead and initial each statement below to signify you understand or verify this intormation. 0-t -Y:. I understand a lrequent practice of unlicensed persons is to have the property owner obtain an "Owner-Buildel' 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 financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowneas insurance may not provide coverage for those injuries. I am willlully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to ryorkers on my property. t/t -.-<"' 2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. kr. ,understand as an "Owner-Buildea' I am the responsible party of record on the permit. I understand that I may protect myself from potential tinanclal risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. Y?-+. t understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts.A.-'t - 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value ol my construction is al least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. ///'\ 6. I understand if I am considered an "employer" under state and Federal law, I must register with the state and iederal gouernment, withhold payroll taxes, provide workers' compensation disability insurance: and contribute to unemployment compensation ol each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. Wr. ,understand under Cali{ornia Contractors' State License Law, an Owner-Builder who builds singlejamily residential structures cannot legally build them with the intent to offer them for sale, unless a//work is performed by SANTA ANA CITY COUNCIL CIry N,4ANAGER Rau Godinez ll r CITY AfiORNEY Sonia R. Carvalho ^CLERK OF THE COUNCIL Maria D. Huizar mpulido@sanla-ana.oro Vrcente Sarmiento vsarmrento@santa-ana.oro isolono@sanla.ana.oro P. Davd Benav des dbenaqdes@sanla.ana.ord lvil eoas@san16-ana.o,.sl naiero@sanla-ana.oro Michele ^4aninezMayor Pro Tem. Ward 2 mimartinez@sarla-ana.oro ijcensed subcontractors and the number o{ structures does not exceed tour within any calendar years, or all of the work is . 'perf ormed under contract with a licensed general building Contractor. tl4 -/'tz L l 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 sustaihed by any subsequent owner(s) that result from any latent conslruclion defects in the workmanship or materials.b--\ - 9. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Service, the United States Small Business Administration, the Calilornia Department of Benefit Payments, and the California Division of lndustrial Accidents. I also understand I may contact the Calilornia Contractors' State License Board (CSLB) at 1 -800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. Y- rc.I am aware ol and consent to an Owner-Builder building permit applied {or in my name, and understand that I am the oarlv leqallv and lirranciallv respon aooiess, {01 U.Swra, Zh<.rr sible lor oroDosed construction activitv at lhe lollowino A.f E.' (,..^s'r A Nrorr CA9+?o 9 " l, -,--\" lt.I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. 6. tagree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the ihlormation 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 ol 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 ol their workers' compensation insurance coverage. Belore 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. /Vore.'A coDv of the DroDertv wner's driver's license. form notarization, or other veri tca tion acceDtable to the aoencv is required to be ted when t.he Detmit is issued to the owner's Signature of Property Own Date Ur' n 4q Print name of Owner i":Z AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Properly Owner, the execution ol which I understand is my personal responsibllity, I hereby author ze the fol owing person(s) to aci as my agent(s) to apply for, sign, and file the documents necessary 10 obtain an Owner-Buider Permit for my project. Scope ol Construction Project (or Description of Work) Project Location or Address Name of Authorized Agent Address of Authorized Aoent 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 oul the above information and certify its accuracy. Property Owner's Signature Date Print Name ol Owner Note: A copy ol the owner's driver's license, torm notarization, or other verilication acceptable to the agency is required to be presented when the permit is issued to verify the properly owner's signature. SANTA ANA C]TY COUNC L mouiido@sanla ana oro Mayor Pro Teh. Ward 2 m man neu @sanla ana oro Vrcenre Sam enro vsarmrenlo@sanra'ana oro lsolqi!@sa!.la:ala dbenav dcs@safla ana oro ivile9as@rda:ala.sl naiero@sanla.ana.oro