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MAYOR MiguelA. Pulido MAYOR PRO TEIV t\,4ichele l\,4artinez COUNCILMEIVlBERS P. David Benavides Vicente Sarmiento Jose Solorio SalTinajero Juan Villegas CITY OF SANTA ANA PLANNING & BUILDING ACENCY 20 Civic Center Plaza P.O. Box 1988 .santa Ana, California 92702 www,santa-ana.orglpba NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted in your name listing yoursell as the builder of the property improvements specified ^, )04f,aEf {r1u--at)"-lfu.,t-)0 We are providing you with an Owner-Builder Acknowledqment and lnlormation Veriflcation Form to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your names as the OwnerBuilder. We will not issue a building permit until you 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 ACKNOWLEDGMENT AND VERIFICATION OF INFORMATON DIRECTIONS: Read and initial each statement below to signify you understand or verity this information. ,t' /-l-$t1. f understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" qS0ilding permit that erroneously implies thal 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. Nily 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 property. .\|U*' z. I understand building permits are not required to be signed by property owners unless they are responsible for tli6 construction and are not hiring a licensed Contractor to assume this responsibility. ^.t0H" S. f understand as an "Owner-Buildel' I am the responsible party of record on the permit. I understand that I may protect mysell from polential financial risk by hiring a licensed Contractor and having the permit filed in his or her name inslead of my own. lf,rLO I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts CITY MANAGER Raul Godinez ll CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL l\,4aria D. Huizar 5. I understand if I employ or otherwise engage any persons, other than Calilornia licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer" under state and federal law. (, \\-U , understand if I am considered an "employer" under state and Federal law, I must register with the state and lederal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute 10 unemployment compensation of each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. \rM ,. I understand under California Contractors' State License Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them lor sale, unless a//work is performed by SANTA ANA CITY COUNCIL { moulido@sanla.ana.oro Mayor Pro Tem, Ward 2 mimaninez@santa-ana oro vsa.mrenro@sanra ana oro lsolono@sanla ana oro P Davrd Be.avides dbenav des@santa-ara.oro iville.as@santa-ana.oro sl naiero@sanla.ana.oro