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9r,/oszq <br />MAYOR <br />MiguelA. Pulido <br />MAYOR PRO TEIV <br />Michele t\,4arline2 <br />COUNCILI\,,IEIVBERS <br />P. David Benavides <br />Vicente Sarmiento <br />Jose Solorio <br />SalTinajero <br />Juan Villegas <br />CITY IVANAGER <br />Raul Godinez ll <br />CITY ATTORNEY <br />Sonia R. Catualho <br />CLERK OF THE COUNCIL <br />lvlaria D. Huizar <br />CITY OF SANTA ANA <br />PLANNINC & BUILDING ACENCY <br />20 Civic Center Plaza <br />P.O. Box I988 . Santa Ana, California 92702 <br />www,santa-ana.org / pba <br />NOTICE TO PROPERTY OWNER <br />Dear Property Owner <br />An application Ior a building permit has been submitted in your name listing yourself as the builder of the property <br />imorovements soecif ied at <br />-: ,/S/ S' i4 €z-€vA1, rm ,jr <br />We are providing you with an Owner-Builder Acknowledoment and lnformation Verification Form to make you aware of <br />your responsibilities and possible risk you may incur by having this permit issued in your names as the Owner-Builder <br />We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned <br />this form to us at our oflicial address indicated. An agent of the owner cannot execute this notice unless you, the property <br />owner, obtain the prior approval of the permitting authority. <br />WNER'KN WLE MENT AND VERIFI ATI N F INF RMAT N <br />TIONS: Bead and initial each statement below to signify you understand or verity this information. <br />ul ldln <br />1. I understand a frequent practlce of unlicensed persons is to have the property owner obtain an "Owner-Buildea' <br />g permit that erroneously implies that the property owner is providing his or her own labor and material personally. l, <br />as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed <br />person and his or her employees while working on my property. lvly homeowner's insurance may not provide coverage for <br />those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to <br />workers on my property. <br />2. I understand building permits are not required to be signed by property owners unless they are responsible for <br />e construction and are not hiring a licensed Contractor to assume this responsibility <br />3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may <br />rotect mysell from potential financial risk by hiring a licensed Contractor and having the permit filed in hls or her name <br />instead of m y own <br />4. I understand Contractors are required by law to be licensed and bonded in California and to list their license <br />mbers on permits and contracts <br />5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the <br />al value ol my construction is at least live hundred dollars ($500), including labor and materials, I may be considered an <br />mployer" under state and federal law, <br />6. I understand if I am considered an "employer" under state and Federal law, I must register with the state and <br />ral government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to <br />unemployment compensation of each "employee." I also understand my failure 1o abide by these laws may subject me 10 <br />SANTA ANA CITY COUNCIL <br />moulido@sa.la-ana.oro <br />Mayor Pro Tem, Ward 2 <br />Er-Eadlez@lafla:@ <br />Vrcent€ Sa.miento <br />vsam enlo@santa-ana.oro i$lqi!@sada:!!i <br />P. Oav d Benavides <br />dbenavides@sanla-ana.oro jviLlggaE@sada.a!@ stinaiero@sanla ana.oro <br />IsRrious financial risk, <br />A-L-, I understand under California Contractors' State License Law, an Owner-Builder who builds single{amily <br />"(/dbiOentiat structures cannot legally build them with the intent to ofler them {or sale, unless a//work is performed by