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MAYOR <br />N/iguel A. Pulido <br />MAYOR PRO TET,l <br />N4ichele Martinez <br />COUNCILMEMBERS <br />P. David Benavides <br />Vicente Sarmiento <br />Jose Solorio <br />SalTinajero <br />Juan Villegas <br />CITY IVIANAGER <br />Raul Godinez ll <br />CITY ATTORNEY <br />Sonia R. Carvalho <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.orglpba <br />NOTICE TO PROPERTY OWNER <br />Dear Property Owner: <br />An application for a building permit has been submitted in your name listing yourself as the builder of the property <br />improvempqts specif ie4at('-Craz c fIl ae, A \[aLxPz utAlA <br />We are providing you with an <br />your responsibilities and poss <br />rBuilder Acknowl ln ation Verification Fo to make you aware of <br />ible 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 official 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 />OWNER'S ACKNOWLEDG MENT AND VERIFICATION OF INFORMATON <br />DIRECTIONS: Read and initial each statement below to signify you understand or verify t his information. <br />fu ', , understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" <br />building 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. My 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 />-N r runderstand building permits are not required to be signed by property owners unless theyare responsible for <br />the construction and are not hiring a licensed Contractor to assume this responsibility. <br />Il/ 3. I understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may <br />protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name <br />instead of my own. <br />-N O , understand Contractors are required by law to be licensed and bonded in California and to list their license <br />numbers on permits and contracts. <br />N U. tunderstand if I employ or otherwise engage any persons, other than California licensed Contractors, and the <br />total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an <br />"employer" under state and federal law. <br />U/ A. I understand if I am considered an "employer" under state and Federal law, I must register with the state and <br />federal government, withhold payroll taxes, provide workers' com pensation disability insurance, and contribute to <br />unemployment compensation of each "employee." I also understand my failure to abide by these laws may subject me to <br />serious financial risk. <br />N ,. lunderstand under California Contractors' State License Law, an Owner-Builder who builds single-family <br />residential structures cannot legally build them with the intent to offer them for sale, unless a// work is performed by <br />mou do@santa ana.oro vsarmienlo@sanla-a.a oro l!9L9ri9@!g!1e9!as9 dbenavrdes@sanla-ana oro ivilleoasrAsanla-ana oro srinaiero@santa-ana oro <br />SANTA ANA CITY COUNCIL <br />Mayor Pro Tem, Ward 2 <br />mrman nez@sanla-ana.oro