HomeMy WebLinkAbout10110573 - Permito)o(Daqa3Ke
3aa
oooc)oo)oqq\\q\a?
ro@(o $cf)o)roNro a N|.f)l.-c')@@@Ag@
ido=?60Eo oee E'nrP .9s[ ff
9o
e !;E q
o a o -eJ
,,r: $ E'}d Egf;Eqs,tg
esE;g.gE
c')oooo\a?q\\co$$(oFC! - (f,) tf)c,?o @@o
r-{OOOC\OHooNoHoobbNO\Ob\OH(v)f\\tHHHto lo to c\ to to tft
c\c\c\HC\c\c\oooooooooaoooo\o\o\oH\obb
HHHOHHHHHHqHHHHHHAHHHooooooo
o
oF
$(o
rf)f:.
o NooOOrl.-O(O(o(of-OrF l:.$rororf)lr)N
NNNNT-oooooooooo(O(o(O(OrrFO
O)rr-@ooooo
,, iJ ;Jo- o- o-'o 'q.) 'o()o(Joootttr
orio.9 .9 .9,
+tcfooo
oozz
F!F(\t (\ :;oo(-,ht(\to\,,_ \r(D SI LLFOI\\.9a) (9 +'ooE
gggo9
o(U$=OOOc)rf)oo
ca(o
r
IoNoN
iio
l-o+.ooo-as
E\
iEI9xE
H gB
tteLoocqro'ooo
E ;r
ef B
-.->t.'I\H3€ NE o6
=lr\
Esi
sE },
si.I E
SHES
; EE;
:.9 \='E.=a o\ Ees
ssr t
oz
ijoo
E.;
oO
ocoNEoo
LL
T';-o-;s
orrtrci.aO-cacO()(D:.r- OLL O-Gase
=-$oco=JN
2 222
il- :Etb ; Pt__O-i a a E sP 7
E E E l" e AP; E fr: T;B
E ? E H = EEo co 6o_ S coho- o- o- z o-o-J
BtF
,E8C)
eE g?3
69he"-sS
A: E H 1E
Eg E i BE
#
ooaCCoo-c. .9O-J
+rl-o(l) aoc u_).=o9
F.-bitoEYOE
#
oOaCCoo-c. (Jo-=
aao
EE
uo
C)
.co)Ct!
oocg)a
E
.9
(ooc
8.
Eoid id9q E.e * i_ id a
EE!;gsfi,ia
L-o!,
=o
Lotr
=o
UofiaEE
CEOE
tl\N
gat
E 8 E 5
az6,^:
E*ET
+Jotrc(Uotr.c, oo.F
aUOoo
Ei
t7
t
,,)
far\
u)o
F
Fo
F
,#
.=sF-Lo
o-
E)?-
E
a-3cao3
ro
I-N-f+(o
.4.$tE
H
.9+,ooo
f-o9! t*oyoBA
(j@
ofosl\L.
(u@e(o(oas
.{, lt-O) \/
5a
=6 o15fNOooo-t
r-Coo+aF+tsg.9?
ooooN@ lr)*s3I . .
GU+,
-l-LOcgF0=trOH(J!t
'.JF;ad\J o-
otro
a-+,
Etroo
ED
.=trtrg
o.
?-o
E
Lola-
Lotr
=o
+o
Ft+t
e-op
(U
CL
o
U'D
q,
EoolLF-+.
(E
lt
F
€
$€
(Y)
a
Eoo
L.t,o
-o
EooL-
=E
(Uta-
EE'
(U
?Lo
a-+,
EE'(E
o
{r,
$t+t
Eoof-E'o
.cl
o+,
Go
-9ol-
I
?-.9
.=
Eg
.YLo
=tFo
?-o
a-+,
CLa-
Loooo
oqooo_o
C')o
r(, loF- l\to (o
uc 8g
Jifr-O)
lJ-Lr-oo?tEE85E
t
CteP.EE+,
a(EE3l--o(U
iTiol-
*,o-o-F
-)$
s
cDo
-$lo(")=) i(s
"m8E
;R id a
Ft ,A E36 o p ao C E A E666 0 0O()OTL:tt
E')
E
E3oo E)3HE E')
(E.,Ii;E €
o) .= \ri=-.= E 3
'rt E' t, !{L - - u.-tur-
Ef
{od oB €83--JhiLmEP*3Pfrp =i a
=€6i9m;zuo-
F
E,
id ii,cDc
LFtoXEN
o=
U)
aa
+h
?-a-o.
oz
o
o
.9-
tt)o)Cotr
aaq)
Eo
ij,9
c0
F(0o(\
o(E
F
z
.Yc)o
m
.!cf
l()\f
oJ
o
?'
Il()N(\t
I
Foo
::o()
$
o-
a
oaaoaa
fl
(trl
-lolol
o-l
zl
$lcol6ilNI
oo
E
E'E'
+,
C)o.qot
a
a
\
TDsrg
zoI
=aT
rno{onv
rnoovI
t
I
l.
)r
,aalr
)(
F
I
F
D
(
I
oo
o)
=f+r
o)
U
e€g
5ac
o)
=.o
=m
=o
-l3c
l1
-lo)
3
='3f,
@:to
o)
-I
=g
\Too
-ira
o
o)
==o
o
=5
@C
o)*.o
=
ar
(D
i-rI
oo
-l
\
Cl1
m7
o
-loc
=o-
t
rn.loo*.of
-u
oo-
CN
\
'Tt
o-3
@
CN
oo
-
9_o-o{
=@
ao.+
TD
o)
C)ir
CN 9,{
rn
I
=o7x
.Tl
z
r
:Iooo-
No
=o
oof.+r
m
=(o
='oo
-lrl
=o
vo]Co
=
UoI)C
l1
=gL
vooo
=
J-
0)
=o-
C)'
o)o
To.o
-{t
tpo
-l
-U
oo
l1o
=oo
o)
@o
=-l
oo;r
-t{r
6'gl
F}o
o{r
.Sss
(
rT
I
c
N\
\
\
Q
t
N
Y
!$G
N \.)A
(]
{
rn
S.t
Nt)
\,C
O(
(
U
^)lb
N
r
N}
r
C
.I-\'t !
N
F
N
\\
I \.!\
E
9,
F'
3
a,
(\
A
K
$b
?NJ
-
F
u
zo
oI
7o
3q)
-lirI
m
t,
C
\
IN\
\
N
\i
\t
)
s t\4 {
\
I
I
(
\
T(
,,
\
T
D.q
Y
oo
==rTz{
@
E ili e rg
a d 3.g o'r P,i sU X'5 5p :'5'X o- :E *a 6 P=e; i e **
?g 1r 3 x
a r 3 H ?.+{?*,-*e,
E E iIiE
=E[1;
il
: s r3 a;
='?{pzI,,=g^*eo
BAE}fi
3 i; 3g F ie aE i'o g
it€ *E I5 &1;6'n'
as{rEI
ac i 1i i8loElH,eBE, r;g
r; r s€
E rF'8fiera:;- E'": € IqVA H dBBEBF
-gEgr!
5Ha5'- vt { 59SaItl
iE rf{
tr g E tr:
* H I Ei
3 I H'p€
F[] [g
F$[afgFlgt
1F=nBX rh r5-*2 Z i ?,
efi isiArHBgss*q.9t&g ?'t
EEgflE
iE trg
aAls*
F$gEH
At 'iu
t
tsot
-to
o
o
'o
a!I
.B
oxo
o
g
f)oT
0).)
='qa
3.
=o
fD
lnoo.
.)o
o)o
o
U,
5'
o!
€.(D.)
(/)I
3trqba5'E8'ar
q,
o.
Jd
trU'6'trooo.!t
-i
ooo
E'
g)r)
5
(n-
a)g
ano
t-
A)
€
o.o
E
o
9'15
13ie
o
o,
o
q
{
o
CE
=o.o
o
o)
o
o
oo
o).J
0a
t,Eo
ro
.a(!
fl
t,{
A)oo
A'o
o
(/)
1'
IA
n)
o
roo
tno
l_
o)
E
o-c
a
o'
arz
:t.D
oC
o)it
li
oo
x
o,
o
!
.8.cao5o
rl$,_
a?Lo-og
atEx{i=o
EE
I'EB=,Ps)
o i!'o:1
!:r ooP.
9odo*a
:io
;E
95
=ads
EF5E
-(io:O
ri' xq,
CDo+*
o
ut
ar'o
rdg
B6'tt,
E
d
s.ooo.
o',
C
a
E
o
{oo
o
o
:tl
TT
rO
-!)o'5-rQ.
4t
=r j.
P:i
ta2
HO,ils'3{
a'*
ag
8-8
€E
SBroO=vl ='se59'
EH
B'B
6'-t:.8
v, t'
5s.Bgo^ cr)E8
fDo
P t-rad
E3
5'+t<+EoEr3Atrs
P.)t?e
.o
o'
o
Eo'
A)
o(D
o
3
o
2tr
r
I
I
I
g
o(
8t
o, l-
U'
og
H.sO-5f6ts
C!,
-CaEr
;E
a ii')
(!FJ*Eo:,
r6i
Qo
96l<Ei6rDt*
O-r={
?Eti=
o(,A)tEOaI
J='F'a'
P6'tL
?,#8.
ll u,
rE
'*r [i
9qo=E-go.o
Heo<
Ex
vt ultro
€: !r(D p'6!,ie
rE
o
o*oul
"o
x
lh
A,
o
io
o
tt
o
t,
o
(r)o.)
o
(,{oo
o
org
ooo.
.o
o
A,-
oI.o
o
t,
o
t/,
{
F2
z
O
T1
A)
=o
o
U,I
oto
Fo
U,
ao
E
B6'
oo
o
qt
OQ(D
tt
cr7
DO
A)5
o
fo
o
o
o
t rE
a
CDo
E.o
oEln
Bo
o.o
E
ar7
v1
Oo
Eov
ooU'
o
o)IA
(/)
g
o
bg
o)5o.
q
(D
C
c
oo
A)
o)
\o
oo
o
.)
0a
I
aI
o
E'_looo
o
U
o
o
lrJ t
o
o
CEEtt,
='g
6
o)
aru
o
d"U'
o5lhooa
.o
P
o-
()
o
a(!
tn
='
c'
o'
f)
TD
ol,
o.
(!
:!(D'a
fo(D
t,
3
o,
u
t-
fizE
dr
t?
?
o7troqe:ga-s3(, -{o5roc{5
11 (!
iE
o
Etf.
a
t!)*Eloolo6'lzp lct:r, l-l
AEt[.h I-'i
6'k)=lz
.D IF
a kll
Et3dlzslo
;h_lz
{p
o'
o)
f)o
o
otora
*()
?,tn
EJ
6'
-o
a
.D
,r'r'z
A,
e
F:]otl
Vr'
oo-
Ett,
;o
s
P.
3',
I
a(D
x
B)
o
xr-j.tr
o
oo
(!
al>
=ti?IP
E16o. ID8|.16t l-'lils
3.tPa ft-rt>
IEl..l
15lz
tu
ti
tnt
a,
ff
oIAzo
oo)
5'
tl',
CDo.o
o)
v(D
oo
E
D)
o
u,
-l
6-5.9
tl,
o,
o,
E'
(D
o
zo
=.3loo)
o
l_
a,o
a?
A)
o
ta'o.o
q)
Ic
D)
5'
r,
rD0s
Eo
0q
o)an
tr
oo
(D
o
9'
q
(D
I
o)!,g
a,
A,d6'
o
tn
E
e.
$
l_
o
E
a?
q);b,
o
ooto.
t,
!t.o
g
a)
o)
6'
o)
o.
2
Po
o
o)
8'
(D
oo
f,(!o-
A)
o
F'
ooo
E
o
&
g
.,g
0,
o.a
g)
or
t
(!
b)
oa
o
6
o
oc
Bo.
(T
oC
q)
o.
o
E
E
.D
O)I
o
o
o
oAio
ox
J
o'
.o
'o
aD
oEt
CEg
rg
.D
aa!
!i
(D
fi
><l R
$
$\
(
t(
\
h-
q
A)
+.o
o
t
Planning & Building Agen!:y
Building Safety Division
20 Civic Center Plaza
P.O. Box 1988 (M-19)
Santa Ana, CA 92702
(7141 647-5800
\r[/\,t vv.sa nta -a n a.o rg
)
APP-13 CBC 2016
NOTICE TO PROPERTY OWNER
Dear Property Owner:
An rm name listing yourself as the builder of the property improvements
specified
We are providing you with an Owner-Builder Acknowledqment and lnformation Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this permit issued in your names as the Owner-Builder.
Wewillnot issue a building permit untilyou have read, initialed your understanding of each provision, signed, and returned this
form to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner,
obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEGMENT AND VERIFICATION OF INFORMATON
DIRECTIONS; Read and initial each statement below to signify you understand or verify this information.
//
l%-r/4. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" build-
a{ylgii$rmit 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-
I understand building permits are not required to be signed by property owners unless they are responsible for the
and are not hiring a licensed Contractor to assume this responsibility
understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect
potentialfinancial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
and contracts.
I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total
my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an
under state and federal law.
I understand if I am considered an "employer" under state and Federal law, I must register with the state and federal
ment, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment com-
of each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk.
I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential
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 general building Contractor
I understand as an Owner-Builder if ! sell the property for which this permit is issued, I may be held liable for any finan-
injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workman-
or materials.
l'
a
r-
understand I may obtain more information regarding my obligatiohs as an "employer" from the lnternal Revenue Ser-
States Small Business Administration, the Californiapepartment of Benefit Payments, and the California Divi-
Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-
321 L or wvrnrv.cslb.ca.qov for more information about licensed contractors
aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the
and financially responsible for proposed construction activity at the following ad-
that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
a and requirements that govern Owner-Builders as well as employers.
to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
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' compensation 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. Note: A copv of the oropertv owner's driver's license. form notariza-
)
Date:3
Print name of Owner (
AUTHORIZATION OF ENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personalresponsibility, 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.
ScopeofConstructionProject(orDescriptionofWork):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Age
Phone Number 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 Owner'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 presented when the permit is issued to verify the property owner's signature.