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HomeMy WebLinkAbout815 N French St - Misc. PermitPlanning & Building Agency Building Safety Division 20 Civic Center Plaza P.O. Box 1988 (M-19) Santa Ana, cA 92702 (714) 647-s800 www.santa-ana.org rl APP-13 CBC 2016 An applicati specified at on for a build i perm ifhas NOTICE TO PROPERW OWNER nsu mitted in your name listing yourself as the builder of the property improvements a4- WeareproVidingyouwithantomakeyouawareofyour responsibilities and possible risk you may incur by having this permit issued in your names as the Owner-Builder. OWNER'S ACKNOWLEGMENT AN VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand or veify this infomation, @.r. , understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" build- ing permlt 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 prop- erty. fu t 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. J413 ' understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential flnancial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. ,)y' ' 4. I understand Contractors are required by law to be licensed and bonded in Cafifornia and to list their license numbers 5ffimits and contracts. -[lnf u , understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. .lt/" b. tunderstand if lam considered an "employer" understateand Federal law, I must register with the state and federal -govemment, withhold payroll taxes, provide workeri' compensation disability insurance, and contribute to unemployment com- pensation ofeach "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 1,to\ Z. f understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by licensed subcontrac- tors 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. .-9\ a. f understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any finan- cial or personal inJuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman- ship or materials. Dear Property Owner: We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this form to us atour 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. a . -fl& I understand I may obtain more information regardipg my obligations as an "employef'from the lnternal Revenue Ser- vice, the United States Small Business Administration, the Caiifqrnia Department of Benefit Payments, and the Callfornia Divi- sion of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 'l -800- 321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. ]inA ',0 I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the !*.1*r"r,fliryTi:,1i1{rfr"$l'ble for proposed construction activiry at the followins ad- IDA t t. I agree that, as the party legally and financaally responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. fu^ n.l 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 Conkactors 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. Signature of Property Owner Dare: 7-T- 79Zo Print name of Owner If*{. ^I44 o. i,< 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)t-^ l\t-T,\ J \[^t'o-,/\ 8 t ; (i^"1 Name of Authorized Agent: Address of Authorized Agent: I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Property Ownef s Signature Date Print Name of Owner: Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is re- quired to be prcsented when the permit is issued fo verify the property owner's signature. 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 propertv owner's driver's license. form notariza- tion, or other verification acceotable to the adencv is reouired to be presented when the permit is issued to verifv the prooertv owner's s io n atu re. D Project Location or Address: Phone Number of Authorized Agent: CITY OF SANTA ANA PTANNING & BUILDING AGENCY 20 Civic Center Plaza P.O. Box I 988 . Santa Ana, Californta 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 o{ the property imorovements soecif ied at ."evev"'ev'' 3 t" ru fo. ist 9-. !p-,n.' Nn,,. , aa 1L} "L We are providing you with an OwnerBuilder 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. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFOBMATON DIRECTIONS: Bead and initial each statement below to signify you understand or verify this intormation. Ah_1. I understand a frequent practice ol unlicensed persons is lo have the propeny owner obtain an "Owner-Buildei' building permit that erroneously implies that the property owner is providing his or her own labor and material personally. l, as an OwnerBuilder, may be held liable and subject to serious linancial risk lor 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 vrtillfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. /f'9 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. 3. I understand as an "Owner-Buildei' I am the responsible party of record on the permit. I understand that I may protect mysell from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead ol my own. ,Ar.+. 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 " S. lunderstand it I employ or otherwise engage any persons, other than California licensed Contractors, and the 'total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. bA. I understand if 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 of each "employee." I also understand my failure to abide by these laws may sub.iect me to serious financial risk. /i I . I understand under California Contractors' State License Law, an Owner-Builder who builds single{amily residential structures cannot legally build them with the intent 10 ofler them for sale, unless a// work is performed by CITY [,llANAGEB Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. Huizar SANTA ANA CITY COUNCIL ,losc Sol.rio moLldo@sanla ana.oro lrayor Pro Tem, Ward 2 mlmarlrne2@sanra ana.oro vicente Sarmiemo vsarmienlo@santa-ana.oro MAYOR MiguelA. Pulido I AYOB PRO TEIU lvlichele l\rartinez COUNCILIVEMBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas ivillecas@salra:4la-qq slinaiero@sanra ana oio licensed subcontractors and the number of structures does nol exceed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor, -B- A. I understand as an Owner-Builder if I sell the property lor which this permit is issued, I may be held liable {or any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. fh 9- I understand I may obtain more information regarding my obligations as an "employea' f rom the lnternal Revenue Service, the Uniled States Small Business Administration, the California Department of Benefit Payments, and the Calilornia 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 Ior more information about licensed contractors. 1..fi." lO.l am aware ot and consent to an Owner-Builder building permit applied for in my name, and understand that I am fhe party legally and financially responsible for proposed construction activity at the following address: t,+ N. ir,1t.' Sz . Sc-.u,. As^ . ( O 9 z-) " r 1 1. 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. 4 iZ.t agree to notity the issuer of this form immediately ol any addilions, deletions, or changes to any of the 'infdrmation 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 10 assist you with any linancial 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. ll you obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible Ior verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to lhe agency responsible for issuing the permit. Note: A copv of the propertv owner's driver's license, form notarization, or other verification acceptable to the aoency is required to be Dresented when the Dermit is er Date t lSignature of Property Print name of Owner €z- Eru <,O LVC 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 responsibilily, 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 Permil lor my project. Scope of Construction Project (or Description of Work) Project Location or Address Name of Authorized Agent Address of Authorized Agent Phone Number ol Authorized Agent ldeclare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify ils accuracy. Properly Owner's Signature Date Print Name of Owner Nole: A copy ol the owner's driver's license, torm notarization, or other verification acceptable lo the agency is required to be presented when the pemit is issued to verity the properiy owner's signature. t-.: : tr /-j,..rl) ti:r rt.,| . (r 1. lri.1,r,:,r i :: . i : 1 :ti,l.j SANTA ANA CITY COUNCIL noulrdo@santa.ana oro lrayor Pro Tem, Ward 2 mroan'nez@saola.ana oro Vicenre Sarmiento vsarmrenlo@sanla.ana oro isolorio@sanla.ana.oro dbenav des@sa.la.ana.oro Nrlleoas@sanla-ana oro snnaie.o@santa.ana.or. issued to verifv the proDertv owner's sianature.