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Home My WebLink About914 S Bewley St - Misc. PermitMAYOB Miguel A. Pulido MAYOR PRO TEM N.4ichele l\rartinez COUNCILMEMBERS P. David Benavides Vicente Sarmienlo Jose Solorio SalTinajero Juan Villegas CITY OF SANTA ANA PTANNING & BUILDING ACENCY 20 Civi. Center Pla2a P.O. Box I 988 . Santa Ana, california 92702 www.santa-ana.orglpba NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted in your name listing yoursell as the builder ol the property '^o'ryf4"^t*"/il:fl7L sa Sa,h fr,.^-. ch lt)oq We are providing you with an Owner-Builder Acknowledoment and ln{ormalion 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 ol each provision, signed, and returned this lorm to us at our ollicial address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval ol the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signity you understand or verify this information. L^/ 1. I understand 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 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. Ivly homeownels insurance may not provide coverage for those in.iuries. I am willlully acting as an Owner-Builder and am aware of the limits of my insurance coverage lor injuries to workers on my property. -LltJZ. 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 Iicensed Contractor to assume this responsibility. tF-l S. I understand as an "Owner-Buildel' l am the responsible party of record on the permit. lunderstand that I may protect myself from potential financial risk by hiring a licensed Coniracior and having the permit filed in his or her name instead ol my own. Li-/ 4. I understand Contractors are required by lawto be licensad and bonded in California and to listtheir license numbers on permits and contracts. L-t'5. I 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. Ut A. I undersland il I am considered an "employei' 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 ot each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. L^.J 7 . I understand under California Contractors' State License Law, an Owner-Builder who builds single-family resiOentiat structures cannot legally build them with the intent to offer them lor sale, unless a//work is peiormed by SANTA ANA CITY COUNCIL CITY IVANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carualho CLERK OF THE COUNCIL Maria D- Huizar qs!r!c@ra!-la:eB"e!c Mayor Pro Tem, Ward 2 rn nanrne2@santa-ana oro Vicente Sarmlenlo rts!8i9!l!@ti!l4e!n9l!isolorio@sa.ta-ana oro P Davrd Be.avdes dbenav des@sanla-ana.o.o lsle!3s@s3da:a!a4!q sllnaiero@sa.laana.oro licensed subconlractors 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. Ll.l U. , understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any Iinancial or personal injuries sustained by any subsequent owne(s) thal result from any lalent construction defects in the workmanship or materials. .l141g. I understand I may obtain more informalion regarding my obligations as an "employef'lrom the lnternal Revenue Service, the United States Small Business Administration, the Calitornia Departmenl ol Benelil Payments, and the California Division of lndustrial Accidents. I also understand I may contacl the Calilornia Conlractors' State License Board (CSLB) at 1-80O-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. I LLJ f O. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the pa-rty legally and Iinancially responsible for proposed construction activity at the following o L ['J t t. I agree that, as the party legally and linancially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. _LMZ. t agree 10 notily the issuer o{ this Iorm immedialely of any additions, deletions, or changes to any o, the information I have provrded 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 assisl you with any financial loss you may sustain as a result ol 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 be issued, this lorm must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note.' A copv ol the propertv owner's driver's license. ton or other the ,s ted when the Signature of Property Owner Date: Print name of Owner Loc tJ+ eXerJ AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, lhe execulion of which I undersland is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file lhe documents necessary lo obtain an Owner Builder Permit lor my project. Scope of Construction Project (or Description of Work) Address of Authorized Agent:- Phone Number ol Authorized Agent I declare under penalty ot periury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Property Owner's Signature Date Prlnt Name of Owner Note: A copy ot the owner's driver's license, torm notarization, or other verification acceptable to the agency is required to be presenled when the permit is issued to verity the propetty owner's signature. r, r, ir.r,rar i.lfrlrlr ir. :,' hi,r. iulri. . ^.:::i, t. r, -,, t, r" rJ.2: rrl SANTA ANA CITY COUNCIL mpulido@santa.ana or. Mayor Pro Tom. Ward 2 trl4atr-os@saqa:a!!..a4 P Davd Benavides dbenavides@sanla-ana.oro jvine!r9@sada:a!@ sllnaiero@sanla-ana orovsarmrenro@sarra ana.o.o Proiecl Location or Address: - Name of Aulhorized Agent: - irqlpla@salh:alr.la