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Home My WebLink About503 N Daisy Ave & 1917 W Fifth St - Misc. PermitMAYOR lvliquel A. Pulido MAYOR PRO TEM Vicente Sarmiento COUNCILMEMBERS Angelica Amezcua P. David Benavides Michele lllartinez Roman Reyna Sal Tinajero CIry MANAGER Devid Cavazos CITY ATTORNEY Sonia R. Carvalhol CLERK OF THE COTJNCIL Maria D. Huizar CITY OF SANTA ANA PTANNINC & BUILDING AGENCY 20 Civic Center Plaza P.O. Box 1988 . Santa Ana. California 92702 www.santa-ana.orglpba NOTICE TO PROPERW OWNER Dear Property Owner: --'. - q KA t9 tz r*r._, s;fr. S+ . S. A An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at - A\o: U f:o.cw ^Qnwlo Ana-/ 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. OF INFORMATON TIONS: Read and initial each statement below to signify you understand or verify this information. 1 . I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder' it ng permit that erroneously implies that the property owner is providing his or her own labor and material personally. l, an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed rson and his or her employees while working on my property. My homeowner's insurance may not provide coverage for se injuries. I am willfully acting as an O\lr'ner-Builder and am aware of the limits of my insurance coverage for injuries to on my property. I understand building permits are not required to be signed by property owners unless they are responsible for truction and are not hiring a licensed Contractor to assume this responsibility. . l understand as an "Owner-Builder" l am the responsible party of record on the permit. I understand that I may myself from potential financial risk by hiring a licensed Contractor and having the permit flled in his or her name of my own. 4. I understand Contractors are requircd by law to be licensed and bonded in California and to list their license ers on permits and contracts 5. 1 3 alue n li understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an 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 I government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to UN ployment compensation of each 'employee." lalso understand my failure to abide by these laws may subject me to seri s financial risk 7. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family ential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by nsed 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 Iicensed general building Contractor SANTA ANA CITY COUNCIL tuyorPrcTem. Ward 1 Vsamienlo@santa ana oro MManlnez@santa-ana oro An96l câ‚¬ AmezoJa Mme2c!a@santa-anâ‚¬.oro P. o6vid Ee.avides OBâ‚¬nav d6@s6nla-ana.o.o RReha@sanla*na.oro STinai..o@s5nta-ana oro t MPulidoaosanla ana oro I understand ". "n O*n"r- r if I sell the property for which this perrfissued, I may be held liable for any or personal injuries sustained by any subsequent owne(s) that result from any latent construction defecls in tiie anship or materials . I understand I may obtain more informalion regarding my obligations as an "employea'from the lnternal Revenue , the United States Small Business Administration, the California Department of Benefit Payments, and the ia Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board at 1-800-321-CSLB (2752) or rvww.cslb.ca.oov 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 th rty legally and financially responsible for proposed construction a ity at the lowi SS 1'1 . I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by icable laws and requirements that govern Owner-Builders as well as employers . I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the rmation 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 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 ed,ts rm th ust be completed and signed by the property owner and returned to the agency res for u permit. /Vofe.' A copv of the propertv owner's driver's license, ,s Signature of Property Owner Date: Print name of Owner eour}e(0 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) Project Location or Address _-=' Name of Authorized Agent;n Address of Authorized Agent:{ Phone Number of Authorized Ag I declare under penalty of pe r for the address listed above and I personally lllled information and certify its Property Owner's Signature:Date: e Note: A copy of the owner's drivels license, form notadzation, or other veificatlon acceptable lo lhe agency to be presented when the permit is issued to yerify the prope,Ty owner's signaturc PLink:WP51/CounterActivity/AssemblyBillslNotice to Propeny Form 03-14'2016 SANTA ANA CITY COUNCIL sibl ?E: MfiIW lam MPulidolasanla-ana o.o Mayor Prc Tem, W6rd 1 VSamienb@sanle-ana.oro MManin6z@sanl.-ena.oro AAmezcu@santa-ana.oro P David Ben.vid6 DBenavdes@sanb a.a oro RReha@s.nla-ana oro STin6i6ro@s6nr6-rne oro l Print Name of Owner: