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Home My WebLink About801 N Parkcenter Dr - Misc. PermitMAYOR Miguel A. Pulido MAYOR PRO TEM Machele Martinez COUNCILMEMBERS P. Davad Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY MANAGER Raul Godinez ll CITY ATTORNEY Sonia R. CaNalho CLERK OF THE COUNCIL Maria D. Huizar CITY OF SANTA ANA PLANNING & BUILDINC AGENCY 20 Civic Center PIaza P.O. 8ox 1988 . Santa Ana, California 92702 www.santa-ana.org / pba NOTICE TO PROPERW OWNER Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the prope(y improvements snecified at g, ,42ac{-N UNi lT- + Z3{- e[:. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" milding 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 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. C:Nr. , 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. f1lf, I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may irotect mysetf from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. OM ' understand contractors # [:ir],'d[tri;'rt,'u'b" ri"li*I$rho o numbers on permits and eolrfads.: . . '.; . ,',:'.-t . .':\'.'.\.-\.' '.'. onded in California and to list their license .|,t (M t understand if I emptoy or otherwise engage any persofrsig.til6f hhir Eitiiornia liictir,sid Contractors, and the total value of my construction is at least five. hun{fed do.]lars (q{99). incf uding Lapqr.?nd m?lerials, I may be considered an .employer" under state and federal law. 'l\ r'.'.I'i l i'' M I understand if I am considered an "employer" unoe, stite arid r"oiii rai,,'iirrrtt 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 subject me to serious financial risk. l/16 I . I understand under California Contractors' State License Law, an Owner-Builder who builds single-fam ily Eiidential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by SANTA ANA CITY COUNCIL mDUlidolosanla-ana.o.o Mayor Pro Tem, Ward 2 mimartineziosanta-ana orq Vicente Sa.miento vsarm e.10@sa.ta-ana.oro isoloio@sanla-ana oro P. Oavd Benavides dbenavides@s5nla-ana.oro iuX!9!s@s4E:eE slinaiero@santa-ana oro T^-Pt XLru/c-. We are providing you with an Owner-Builder Acknowledoment and lnformation Verification Form to make you aware of your responsibiliiies 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 untit 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 VERIFICATION OF INFORMATON DIRECTTONS: Read and initiat each statement below to signify you understand or verify this information. 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. CUU(8. t 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 owner(s) that result from any latent construction defects in the workman ip or materials 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 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) at 1 -800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. tAtt6 rc.1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construc'tion activiiy at the following address: M I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by dll applicable laws and requirements that govern Owner-Builders as well as employers. At6r., agree to notify the issuer of this form immediately of any additions, 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 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' com pensation insurance coverage. Before 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 copv of the propeftv owner's driver's license. form notarization th s issued Signature of Property Owner Date ,l l,'lt7 Print name of Owner Atn trofx L 4,ny 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 lile the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work), TEA*ttl- I mPrt4,/anpvTt Project Location or Address 1r/ W. PAW^,NTEA zprvE t/Nfftz", Name of Authorized Agent Detta- qEAocnenP Address of Authorized Agent 41o w!W> lBytu!: 2A. 12/?t6 Phone Number of Authorized Agent cltq 7z'l- zztto I declare under penalty of perjury that I r for the address listed above and I personally filled out the above information and certify its accuracy L/ l,,l11Property Owner's Signature Date C&r) r<lll/na\u L 4mra- Note: A copy of the owner's driyer's licenie, form notarization, or ot@fi verification acceptable to the agency is required to be presented when the permit is issued lo verify the property owner'l<lgnalure. i) ., y,r.: ,,).r"1..4.,:t, ti,:rrrrr /u i ir.t ... r. ! .r-i! I ,f : i., 14...i .. SANTA ANA CITY COUNCIL moulido@s6nra,ana oro Mayor P.o Tem, Ward 2 mimarli.e2@santa-ana oro v cente Samienlo vssm e.to@sani8-ana.oro P Oavid Benavides dbenavrdes@sanla-ana.oro NileoasrOsanla ana oro slinaEro@sanla-a.a oro Print Name of Owner: iso ono@sa.ta-ana.oro