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Home My WebLink About509 S Forest Ave - Misc. PermitI MAYOB MiguelA. Pulido MAYOR PRO TEIVl Michele [,4aninez COU NC ILI\,1E IlIB E R S P. David Benavides Vicente Sarmiento Jose Solorio SalTinalero Juan Villegas CITY OF SANTA ANA PLANNING & BUILDINC AGENCY 20 Civic Center Plaza P.O. Box 1988 . Santa Ana. California 92702 www.santa-ana.orq / 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 specifie at .f l*27o We are providing you with an Owner-Builder Acknowledoment and lnrormation 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 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 VERIFICATI ON OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand or verity this intormation. -QEtunderstand 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 provlding his or her own labor and material personally. l, as an OwnerBuilder, may be held liable and subject to serious linancial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. lvly homeownels 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. M z. 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. 5 I understand as an "Owner-Buildea' I am the responsible party of record on the permit. I understand that I may protect myself lrom potential {inancial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. %.' I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. 4 t understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value ol my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employef' under state and lederal law. 4 understand il 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 ol each "employee." I also understand my lailure to abide by these laws may subject me to serious financial risk. ceTl understand under Calilornia Contractors' State License Law, an OwnerBuilder who builds single{amily residential structures cannot legally build them with the intent to offer them for sale, unless a//work is performed by SANTA ANA CITY COUNCIL CITY [,4ANAGEH Raul Godinez ll C TY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL l\,4aria D. Huizar moLlido@senta-ana oro Mayor Pro Tsm, Ward 2 mrman nez@santa-aoa.oro Vicente Sarm enro vsa.mlenlo@santa.ana.oro isolorio@santa-ana.oro P Davd Benavides dbenavides@sanra ana.oro ivillelas@sada:a!@ slinaie.o@sanla-ana.oro \, licensed subcontractors and the number of structures does not exceed four within any calendar years, or all ol the work is performed under contracl with a licensed general buildind Conlractor. Q4i unAerstand as an Owner-Builder if I sell the propertyior wnich this permit is issued, I may be held liable for any financial or personal lnjuries sustained by any subsequent owner(s) that result from any latent consfuction defects in the workman ip or materials 9. I understand I may obtain more inlormation regarding my obligations as an "employea'from the lnternal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the Calilornia Division ol lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or lvww.cslb.ca.oov lor more information about licensed conlractors., ,-2. A.r---: 10. I am aware ol and consent lo an Owner-Builder building permit applied lor in my name, and understand that I am for oroDo+' '4 v/<__ uction aqtivitygart+p-A followino ^/4 -c.4. 9 z-7.3the oartv leoallv and financiallv adoress: " ?O? 5,'sib le sed constr at the S 1. I agree that, as the party legally and financially responsible lor this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. ^ t-12.1 agree to notify the issuer of this form immediately ol any additions, deletions, or changes to any ol the inlormation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. lf you contracl with someone who does not have a license, the Contractors' Slate 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 civll court. lt is also important for you to understand that if an unlicensed Contractor or employee of that individual or rirm is injured while working on your property, you may be held liable for damages. ll 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. /Vote.'A coDv of the Dropertv wner's driver's license, torm notarization,or other verification acceDtable to t aoencv is reouired to be Dresented when the Dermit is Owner to nature. Date f-7- t 7Signature of Property Print name of Owner /+kfzo,,/ 'f" PE/?.t L:i 4- AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Properly Owner, the execution of which I understand is my personal responsibiiity, I hereby authorize the lollowing 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)U; i,/Lot+/3 i QoEf u cLo {2 E 5,f<:1-4/z *tt//rt t/-r/* @-tu3 Name of Authorized Agent ( eci [,'de-c* Address of Authorized Ag "", fof -9'C>r- 4/z- -9fu /r lr/*c4 E"-v OJ I declare under penalty oi perlury that I am the property owner for the address listed above and I personally filled out the above iniormation and certi fy lts accuracy Date: ,'Y- / 2Pperty Owner's Signature rinr Name oi owner , A n-AAl/a- (erz*L7* Note: A copy of the owner's driver's license, torm notarization, or olher verification acceptable to the agency is required to be presented when the permit is issued to verily the property owner's signature. SANTA ANA CIT/ COUNCIL moul do@sanra-ana. oro Mayor Pro Tom, Ward 2 mimarl ne2@saola.ana.oro vicenre Sarrnlonlo vsarm ento@sanla.ana.o.o isdglg@salE:al3 plq P Davrd Benavides dbenavrdes@santa.ana.oro iYile9as@lada:a&-eq Ei!4ie!o@!ada:a@rg Project Location or Address: T- phoneNumberorA"tno,*aesu"t, 7 ? f - 7OL - 7 / Z' I