HomeMy WebLinkAbout15-0774 (2) � ti C[TY OE'DIAMf BAR � � ���'��� �
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BG�3LllING PERM[T APPLICATION
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ELECTRIC METER RELEASE �WA��pBAINt SEAt
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GAS METER RELEASE �i WAI.I FiNA�
SPEGIAL INSPECTION RO R�M�lt`i#1At1�llN�f�PPR{NAL
FINAL BUILDIN� fi0U6N FIRE APPftWAL
FINAL MECHANICAL FItdA�FIRE DEPABTMENT
.........._.___ � .,......_._..........�
F1NtsL ELECfHiCAL FINAL Pt/4NNtNG
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FPNALM.UM6ING FINAt EHGINEEHWG!PW
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CEAT.of OCGUPAHCY FINAL HEALTH DEPT. ..''....
............ �
fINAL INOUStR1AL WASTE
CONINIENTS
ry .
CITY OF QIAMQND BAit
2I810 Copley Dr
D�amaod Bar,CA 91Tb5
BUILD[NC&SAFETY pIV[SION
{909}839-7020
NQTICE TO FR{�PERTY OWNER
Dear Property Qwner
An apphcat�on for a budd�ng permd has been su mitte �n you name,�+�ting y urseif a the budder
of the property improveme�ts spec�ed at / � � f 'sl �' �+ �
We are provid�ng you with an Owner-Budder Acknowledgment and Infarmatian Venficafion Form
tca make you aware of yaur respansibdrt�es and passible nsk yau may mcur by having thEs permit
rssued in your name as the C�vner-Budder We wdl not issue a budd�ng permd untd you have read,
initialed your understandrng af each prawsion, signed, and returned th�s farm to us at aur official
address ind�cated An agent of the owner cannot execute th�s notice unless you, the property
awnee, obtain the prior approval of the permitting authonty
Appl�cat�on Number -,
Pra�ect Address ..%Y' � � � ' G�y' �
DIRECTIt}NS Read and irntial each statement below ta s�gnify yau understand ar venfy this
info marion
Y 1 I underst�nd a frequent praotice of unl�censed persons �s to have the praperty awnar
abtain an "Gwner-Builder" butlding permd that erraneousiy amphes that the property owner i�
provid�ng his or her own labor and matenal personally l, as an Owner-Budder, may be held
Iiable and sub�ect to ser�ous financiai r�sk for any rn�unes susta�ned by an unl�censed person and
his or her employees while working on my property My homeowner's msurance may not
prov�d�coverage far those m�unes ( am wdlfuliy actmg as an Owne�-8udder and am aware of
t limits of my �nsurance coverage far�n�unes to workers an my property
2 � understand buildmg permRs are nat required to be signed by property owners unless
they are responsrble far the canstruction and are not hinng a hcensed Cor�tractar to assume th�s
�re ponsibd�ty
�3 I understand as an "Owner-Budder" ! am the responsibie party of record on the permd I
understand that i may protect myself frpm patential finenciai nsk by hmng a licensed Cantractor
�� havmg the perm�t filed m has or her name mstead of my awn
4 I understand Contractors are required by law to be Iicensed and bonded in Cai�farrna
and ta Iist thein c�ense numbers on permds and cantraets
� � •�1 � �
�5 I understand if I employ or otherw�se engage any persana, other than Cal�forn�a bcensed
Contractars, and the total value of my construction is at Ieast five hundred dollars {$5d0}, �
includ�ng labor and matenats, I may be co�sidered an "employe�' under state and federal Iaw
� i understand if I am considered an"emplayer� under state and federai law, I must
register w�th the state and federa!govemment, wdhhaid payroli taxes, provide workers'
campensat�on disabdity �nsurance, and cantr�bute to unemployment compensatian for each
"employee " I aisa understand my fadure to ab�de by these laws may sub�ect me ta serious
financ�ai risk
7 i understand under Caldornia Contractors' State Licenss Law, an dwner-Butlder who
builds smgle-family residential structures cannot Iegally budd them with the intent to offer them
for sate, uniess ati work is performed by I�censed suboontractors and the number of structures
does not exceed four wdhm any calendar year, or aii of the wark is performed under contract
with a 6censed generai buddmg Contractor
_8 I understand as an Owner-Bwlder if I seN the property for which this permit is issued, i
may be held 6able for any finanaai or personal inauries sustained by any subsequent owner{s)
that result from any Iatent construct�on defects m the workmanship ar matenals
9 I understand I may obta�n more �r�formabon regardmg my ob6gatwns as an"empioyer"
from the Internal Revenue Service, the Umted States Smail Busmess Administrabon, the
Galifomia department of Benefit Payments, and the Gahfomia D�v�sion af Industnal Accidents I
alsa understand i may contact the Cal�fomia Contractars' State License Ba�rd {CS�B} at 1-80�-
321-CSL� {2752} or www csib ca gov for more �nformat�on about licensecl cantractars
10 I am aware of and consent to an Owner-6u�Ider budding permit applied for m my name, and
understand that I am the party Iegally and�nanciaily responsible for proposed constructron
act�vity at the foilawing eddress
11 I agree that, as the party legally and financiaily responsible for this prapased construction
activ�ty, I wdl abtde by aII appiicabie laws and requirements that govem flwner-Butlders as well
as employers
12 I �ree to notify the�ssuer of this foRn immediateiy af any addit�ons, deietions, or changes to
any of the anformation I have prawded an this form Licensed contractors are regulated by faws
des�gned to protect the public tf yau contract w�th samecane wha does not haue a licensa, the
Gontractars' State �icense Board may be unable to assist you with any flnanciai Ioss you may
sustam as a result of a compiaant Your anly remedy against unhcensed Cantractors may be in
civil caurt tt is also impoRant for you to understand that rf an unlicensed Contractor or employee
af that mdividuai or firm �s in�ured whde workmg on your property, you may be held IEable for
datnages If you obtam a permrt as Owner-Budder and w�sh to h�re Corrtractars, you w�ti be
responsibfe for verrfy�ng whethar ar not those Contractors are properly I�censed and the status
af their workers' compensatian msurance coverage Before a bwldmg perm�t can be issued, this
farm must be completed and signed by the propeRy owner and returned ta the agency
respons�ble for issuing the permit
Note A copy of the property owne�'s dnver's hcense, form natanzat�on, ar other ver�ficatwn
acceptable to the agency is required to be presented when the permit is issued ta uenfy the
property owner's s�gnature
4wnet's Name
S�gnature of property owner Date
SEC 3 Section 1983Q of the Health and Safety Code is
repeaied
SEG 5 Seotian 19832 af the Health and Safety Code Rs repealed
. .
� • ,z .
SEC 4 Sect�on 19831 of the Health and Safe#y Code is repealed