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Plannlng & Bullding Agency <br />Bulldlng Sarely Dlvlslon <br />20 clvic Conler Plaza <br />P.O. Box'1988 (M-lS) <br />santa Ana, CA 92702 <br />(714) 647-5800 <br />www,santa-ana.org <br />NOTICE TO PROPERW OWNER <br />Dear Prop6rty Ownen <br />r a buil dlno Dermit has beesI. -@21H16 der of the roperty lmprovementsn submitted in name listi you bu <br />We are providing you wlth an Owner-Builder Acknowlsdoment and lnformation Verification Form to make you aware of your <br />responsibllities and possible rlsk you may incur by having this permit lssued in your names as the Owner-Buildor. <br />We will not issue a bulldlng permit untii you have r€ad, lnitialed your understanding of each provision, signed, and returned this <br />form to us at our officlal address indicated. An agent of the owner cannot execute this notice unless you, the properly owner, <br />obtaln the prior appoval of thB permltting authority. <br />OW}IER'S ACKNOWLEGMENT AND VERIFICATION OF INFORMATON <br />DIRECIIONS: Redd and lnltlal each statoment berow to slgnlfy you understand ot verify thls informallon. <br />-'v t. I undersland a frsquent practice of unlicensed porsons is to have lhe property owner obtain an "Owner-Bulldef build- <br />ing p€rmlt that enoneously implies that the prop€rty owner ls providing his or her own labor and material personally. I, as an <br />Owner-Builder, may be held liable and subJect to serious flnancial risk for any lnjuries 6ustained by an unlicenssd psrson and <br />hls or her employses while working on my property. My homeolvne,'s insurance may not provide coverage for those injuries. I <br />am willfully acting as an Owner€uilder and am aware of the limits of my insurance coverage for injuries to workers on my prop- <br />erty. <br />Y-Z f undorstand bullding permits are nol required to be signod by properly owners unless they aro responslble for the <br />constructlon and ara not hirlng a llcensed Contractor to assume this responsibility. <br />->L-, I understand as an 'Owner-BulEel- I arn the responsible party of record on the permit. I understand that I may protect <br />myself from potential linanclal risk by hiring a llcensed Contraclor and havlng the permit flled in his or her name instead of my <br />own. <br />]-4. f understand Contractors are required by law to be licensed and bonded in Californla and to list their license numbers <br />6i]-erm its and conka cts. <br />\r-S. I underctand if I employ or otherwise engage any percons, other than CaliFomia licansed Conlractors, and the total <br />value of my conslructlon is at l€ast tlve hundred dollars ($500), lncluding labor and materials, I may be considerod an <br />"emdoyor" under state and federal law. <br />)j-o f understand if I am considered an "employer' under state and Fsderal law, I must reglster with the stats and fedsral <br />governmenl withhold payroll taxes, pmvide workers' compensation disability insuranc6, and contribute to unemploymont com- <br />pensation of aach "employee.' I also understand my failure to ablde by these laws may subject mo to serious llnancial risk. <br />_7. I undershnd under Califotnia Contractors' Stat€ Llcsnse Law, an Owner-Builder who builds singlejamlly residential <br />structures cannot legally build thom with tho Intent to off€r them for sale, unless all work is performed by licensed subconbac- <br />tors and the number of sfuclures doos not exceed lour within any calendar years, or all of lhe work is performed under contract <br />with a licensed general buildlng Contractor. <br />- 8. I understand as an Owner€uilder if I sell the property for which ffris permlt is issued, I may b6 held liable for any finan- <br />cial or porsonal inJudos sushined by any subsequent own€r(s) that result from any lstent constructlon defects in tho workman- <br />ship or matorials. <br />APP"!3 CBC 2016