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Bulldlng S.t.ty OlYblon <br />20 Clvlc Crrlor Phz <br />P.O. Box l9t8 (ti-i0) <br />S.nt Anr, CA 82702 <br />(7la) 62a76800 <br />wwwaanta{na.olg <br />APP-1! CBC 2016 <br />Oaar Proporty Orvncr <br />An applrcrtlon for a <br />sp€cfiod al <br />NOTICE TO PROPERTY OWNER <br />has b€€n submdted in name listing yourselfas the builde, ot th€property rmprovements <br />We are prcvdrng you wth an to make you arare of your <br />responsibilrties and possible risk you may incur by having this Permit issued in your names as the O'vner-8uildor. <br />We will not lssuo s builCing permit untl you have read. initialed your understanding of each proviskln, signed, and refumed this <br />tolm to us at our oflicral address indicated- An agent of the owner cannot execute this notice unless you, the property o!r,ner, <br />obtain lhe pnor approval of the petmittrng aulhority. <br />OTRECnO IS: Ro,,d ,nd lnldet oach sl,tol,rfia btow to sunlfy Wu unffind or eodfy dtk ittonnadon. <br />-r:Ll-]1. I understand a ftequent practice of unlcensed prsons is to have the property oi/ner obtaan an 'Owner8uilde/ build- <br />ing p€ImIt that enoneously impli€s that the property otvner as providing his or her own hbor and material personalty. I, as an <br />olxner€uilder, may be held liabb and subject lo serious financial risk for any injuries sustained by an unlicensed person and <br />his or her employees u,fiile working on my property. My homeowoe/s insuEmce may nol provide coverage for those injuries. I <br />am wilfiily acting 6 an O\flner€uilde, and aln aware of the limits of my insurance coverage for injuries to workaYs on my prop- <br />erty. <br />I understand buildang pemits are not required to be signed by property owners unless they are responsible for the <br />constucton and are mt hiring a licansed Contractor to assume this responsibility. <br />_lt[L3. I undeEtand as an 'Owner€urHel. I am the rcponsible party of lecod on the p€rmrl I undersland lhat I may proted <br />miEelt trom potential financial .i3k by hiring a licensed Contractor and having tho pormit fled in his or her nam€ inslead ol my <br />-!fl.1. t urterscna Contrado6 are requircd by bv to be licens€d and bonded in Califomia and b list their license numbeB <br />ofl p6rmil6 and cont'acts. <br />jL\125. I understand if I employ or oth€rwiso engage any persoas, other than Califomia licansed Contractors, and the total <br />value of my consfuclion is at lsast fiv6 hundred dollars ($500). including labor and matedals, I may be consid€red an <br />'empbye!' under Etato ard ,€dd-al bw- <br />fi/6. I undorstand ll I am con$d€Ed an "employq' under state and Federal law, I must.egaster with the staE and federal <br />Cdfomm€nt wthhold payroll taxes. provire u/oakers compensation disability insurance, and contribute to unemployment com- <br />pgn6ation of eadr 'emdoyeo.' I also urdoratand my failure to abide by thes€ laws may gubjecl ma b serious fnancial risk. <br />-2d-f7. I und€r6bnd under Calforn6 Contractors' S-tate Lbens€ Law. an Owner-Builder who builds single-family residenlial <br />6tndlurss cannol lsgaly build them with thg inbnt to offer them lor 6ale, unless a/ work is perrormed by licensed $ibconkac- <br />tofs and th€ number of sfucfuIes does not exceed foua within any calendar yeaas, or all of the work is perfoamed under contaact <br />with a lEerEed general bu drE Conhaclo.. <br />/1^ <br />lh/g t unaer*ana as an Owner€uiuer if I sall fio prop€.ty for which thB permat is issued, I may b€ held liable ior any finaft <br />dal or personal rnlunes sustaingd by any Bubs€quent owne(s) lhat re6ult trom any latenl const ucton defects in the workman- <br />ship or matorials.