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Home My WebLink AboutEven-1972-1976 E McFadden Ave - Misc. PermitIVAYOR llliguel A. Pu ido MAYOR PRO TEN,4 N4ichele Ma(inez COUNCILI\,4EMBEBS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Vallegas CITY OF SANTA ANA PLANNINC & BUILDING ACENCY 20 Civic Center Plaza P.O. Box I988 . Santa Ana, California 92702 www.santa-ana.or9 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 z-4<^J'ru- A.rJA^ We are providing you with an Owner-Builder Acknowledoment and lnlormation Verification Form to make you aware ol 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 oflicial address indicated. An agent ol 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 a or verity this intormation. / N41.)l understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" f builglrg'permit that erroneously implies that the property owner is providing his or her own labor and material personally. l, ;s-s 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. lvly 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 ers on m y property 2. I understand buildin g permits are not required to be signed by property owners unless they are responsible for construction and are not hiring a licensed Contractor to assume this responsibility . I understand as an "Owner-Builder" I am the responsible party ol record on the permit. I understand that I may myself lrom potential linancial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. l@ I understand Contractors are required by law to be licensed and bonded in Calilornia and to list their license numbers on Dermits and contracts.----^- ( \@) I understand if I employ or otherwise engage any persons, other than Calilornia licensed Contractors, and the \otal-value of my construction is at least five hundred dollars ($500), including labor and malerials, I may be considered an "em yea'under state and federal law CITY MANAGEB Raul Godinez ll CITY ATTOF]NEY Sonia R. Carvalho CLERK OF THE COUNCIL l\,4aria D. Huizar lo I understand if I am considered an "employer" under state and Federal law, I must register with the state and overnment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to mo!lido@santa-ana.oro l,layor Pro Tem. ward 2 m marl ne2@sarla ana.oro iv lleoas@sanla-a.a.oro stinaiero@santa-ana.oro era lg unemployment compensation of each "employee." I also understand my failure to abide by these laws may subjecl me to serio!{thancial risk. @. ,undersland under California Contractors' State License Law, an Owner-Builder who builds singleJamily residential structures cannot legally build them with the intent to olfer them lor sale, unless a// work is performed by SANTA ANA CITY COUNCIL vsarmie.b@sanraana.oro lsoloo@santa.ana.oro dbenavdes@safta'ana.oro improvements specified ^, l<1 ?- - | q 1b t_ M uF.*--oe+,1 licensed subcontractors and the number of slructures does not exceed ,our within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. -@. ,understand as an Owner-Builder if I sell the property {or which this permit is issued, I may be held liable for any flhar6ial or personal injunes sustained by any subsequent owner(s) that result lrom any latent construction defects in the workmanship or materials.-'-\ (M I understand I may obtain more information regarding my obligations as an "employer",rom the lnternal Revenue Wice, the United States Small Business Administration, the California Department of Bene{il Payments, and the California Division of lndustrial Accidents. I also understand I may contact the Calilornia Contractors' State License Board (CS LB at 1-800-321-CSLB (2752) or www.cslb.ca.oov lor more information about licensed contractors I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally address: and finan cially responsible for proposed construction activity at the tollowing ,.An/'rF A+JAb,{4-+2At 1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by a ap licable laws and r equirements that govern Owner-Builders as well as employers I agree to notify the issuer of this form immediately of any addrtions, deletions, or changes to any ol the inlormation I have provided on this lorm. 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 coun. 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 issue s form mus completed and signed by the property owner and returned to the agency responsib u h pe . Note: A coDv of the propertv ownet's driver's license, to c ,s ul when the it is issued to veri the ro Signature of Property Owner Date: 1 lo tr.O.J2r'Aa H"- turz-E- AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Propeny 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 1or, sign, and lile the documents necessary to obtain an Owner Builder Permit for my project. Scope of Construction Project (or Description of Work)+D le .2c-\\J.jro.r\ odtk ti 2 {"1?G r-ocation or eoarlS!? ' L"l1Project r 4".\i1c,,-t {1S Name ol Authorized Agent \o^:d u\>Q{.uJ,n Address of Authorized Ag ent: 5"o,r<.' Phone Number ol Authorized Agent ldeclare under penalty of perjury'th intormation and certiiy its accuracy. the address listed above and lpersonal Date: 1 'l'::*l^,e above 1 Print Name of Owner: Note: A copy ot the ILU+D l{at2a174n,?*?F- to the agency is required toowner's driver's license, form rization, or other verilication acceptable be presenled when the permit is issued to verily the property owner's signature SANTA ANA C TY COUNC L ,l l', mo!lido@san16'ana or. Michele Manrnez Mayor Pro Tem. Ward 2 Ersi!-me?@sa!&:a!a.e!9 vsarm'enro@sanra ana oro isolono@sanla-ana.oro P. Dav d Benavides dbenavdes@sanla ana.oro ivilleoas@santa-Fna.oro st.alero@santa.ana.oro Print name of Owner *lD 4..^ L.fr Qz?<x Property Owners Signature: