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Home My WebLink About639 N Fairview St - Misc. Permit? a.o I MAYOR N4rguel A. Pulido N,IAYOR PRO TEM Michele Martinez COUNCILMEMBERS P David Beoavides Vicente Sarmasnto Jose Solorio Sal Tinalero J !an Viliegas ClTY MANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar An application for a building Perm improvements s?ecified ar e 3 CITY OF SANTA ANA PLANNING & BUILDINC AGENCY 20 L vrc Lenter PlazJ P.O. Box l98E . San!a Ana, CalLfornr, 92702 wa\ryv.sanla-ana,or9/ Pba NOTICE TO PROPERTY OWNER Dear Prope(y Owner it has been submitted ln your name listing yourself as the builder of the property /1/. fJt;7tie*C/t /2)ol v"rii".p".r,Orr[r,js and possibi6 riskloi mZliidr by hav,ng 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 if,,i ior. to us at our officiil address ind'icated. An agent of the owner cannot execute this notice unless you' the property owner obtain the prior approval of the permitting authority' ow NER'S ACKNOWL MENT AND VERIF ICATION OF INFORMATON DTRECTIONS: Read and initial each statem ent below to signify you understand or verify this information. o-/, L 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" ourorg p"irit tn"t erroneously implies that the propedy owner is providing his or her own labor and material personally. l, ai an 6wner-guitOer, may be netO iiaUte and subject to ierious flnancial risk for any injuries sustained by an unlicensed . p"*"" ""Jfrs "|' f"r employees while working on my property. My homeowner's insurance may not provide coverage for ino." inluri". I am willfuily icting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my ProPerty. C 2. lunderstand building permits are not required to bg signed by property owners unlesstheyare responsible for th-e construction and are not hiring a licensed contractor to assume this responsibility. /'J 3 Lnderstand as an "Owner-Builder" I am the responsible party of record on the permit, I understand that I may ffi.imysett irom potentiat financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. /')( u o t understand Contractors are required by law to be licensed and bonded in California and to list their iicense umbers on oermrts ano contractsrlU 5. I understand rf I emptoy or otherwise engage any persons, other than California licensed Contractors, and the Otal uatue of my construction is at least five hundred dollars ($500), including labor and materials, I may be consldered an "employer" under state and federal law. I O t understand if I am considered an "employer" under state and Federal law, I must register with the state and -ederaigovernment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to ,,.,",rptJyr"nt.o1.npensationof'each"empioyee.'lalsounderstandmyfailuretoabidebytheselawsmaysubjectmeto seflous financial rrsk. O 7 Lnd"r"trnd under California Contractors' State License Law, an Owner-Builder who builds single-family resiOential structures cannot legally build them with the intent to otfer them for sale, unless a// work is performed by SANTA ANA CITY COUNCIL epa licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work ls performed under contracl with a licensed general building Contractor' B. I 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 sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or materials. /)/ / 9. lunderstand lmavobtain more information regarding myobligations as an'employer" from the Internal Revenue s-ffitce. tne United States Smalt Business Administration, the California Department of Benefit Payments, and the California Division of lndustraal Accidents, I also understand I may contact the California Contractors' State License Board (csLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am rty legally and financially responsible for proposed construction activity at the following address. Q,,I agree that, as the party legally and financially responsible for this proposed construction activity, lwill abide by ble laws and requlrements that govern Owner-Builders as well as employers.all applica eZZ. t agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the lnformation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. It you contract with someone who does not have a ljcense. 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 imporiant 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 lhe status of their workers' com pensation insu.ance coverage. Before a building permit can be issued, this form must be completed and signed bythe property owner and returned to the agency resp onsible fo ermit. Note A coDv of the DroDertv owner's driver's license. form no nz tion or C ,s uired to be ented when the ermit is isgued to verifu the oroDertv o wner's siqnature. Signature of Property Print name of Owner Owner ?/./, r VA,LLL-t"b.- -Jl- (srra<.| alo"\rt.t,l fr. L,^il- Date I AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Exctudinq the Notice to Propcny Owner, the execution of which I understand is my personal responsibility, I hereby authorize the fo ov ng person(s) to act as my agent(s) to apply for, sign, and flle the documents necessary to obtain an Owner-8u lder Permrt Ior my proiect. Scope of Construction Project (or Description of Work) catton a /4b5 F*)rV\C\..../5a-A o'tP.olecl !ocauon or Address NarmL. oI Authorize.i Ag.r nt rhAric rh",'r.'ie ? to-re Gpr.ln Address of Authorized Agent Fftlrr1.- 5 /(e Al)^ otos1 0-1L-7t,3 Phone NLrmbe. of Authori?ed I declare under oenalty of periury that I am the property owne the addre information and certify jls accuracy Property Owner's Sign ature above and I personal filled ut the above Date z h,*b.-Prinl Name of Owner 0-t r rh Note: A copy of the owner's driver's license, form notarizati on. or other verification acceptable to the agency is requircd to SANTA ANA C IY COUNCIL P o3vd 8â‚¬nav'de5 dbâ‚¬.audâ‚¬5'tDs$[a-ane.o.o lvill6oasOsanb-ana o.o nrA be prcsented when the permlt is issired to verify the propeiy owner's signature.