HomeMy WebLinkAbout15-0934 ' ' ' - CITY OF DIAM6ND BAR
DEPe+aRTMENT{}F COMMUNITY&DEVELOPhiENT SERYICES
, 21510 Cvpley Dnve,D3amond Bar,CA 9i76S PfiESS
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CITY OF DIAMOND BAFt '
INSPECTION FtECf}RD
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Building&Safety Divisian
2181d Cogley Drive
Diamond Bar,Califarnia 91765
l9as}s��-�oso F���)s�i-su�
Job Address ���,�� t v�� �f �,{�a�M.�
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Dear Property Chvner
An apphcatzon for a buildutg pemut has been subtrutted ut yonr name stahng yourse�f as the
bualder of the properky tmprovements specihed
Far your protechon,ypn shauld be awaze khat as"owner-buildef' yoa are the respc�nsible party of
record on such a perrnit Butldmg pernuts are not reqnued to be signed by praperty owners ixnless khey are
personally performing therr own work If your work is be�ng performed by someone other than yourself,
yan may protect yourself from possible habitrky�f that gerson apphes for the groper perrrut�n fus or her
name
Contractors are requireci by law ta be heensed and bonded by the Skate of Califomta and to have a
bnsmess hcense from the City of County They are also required by law to put theu license nnmber on all
pemvts for whuh khey apply
If you employ or okherwise engage any persons okher than your imrnediate fazruly, and the work
{uuluding materials and other costs} �s$2fl0 00 or more for the entrre pra�ect,and such persons are not
hcensed as con#ractors or sabcontractors,then you may be an emplayer.
If you are�rt emplayer,you must register with khe stake and federaI gavernment as an employer and
yon are sukr�ect to several abhgahons urcludueg state and federal uicome tax wlthholdutg,federal soaal
secunty t�xes,workers compensahon uvsurance,drsab�ty u�surance costs, and unernployment
compens�hon conkribntrons.
There may be fmannal x�sks for you�f you do not carry out these obhgahons,and these nsks are
espeaally serious with respect to workers compensai�on u�surance
For mare spec�fic xnformahon abont your obhgahons under the federal law,contact khe Intemal
Review Servrce(and�f you wvsh, the LT S Small Bnsxness Atimrn�stratron}. For more specific uiformahon
about ypur obhgahons tuider State law,canFact the I3epartrnent of Benefit Payments and the Ihvu�ian of
Industrial Acadents
If the struc#ure is intended for sale, the proper#y owners who are not hcensed eontractors are
allowed to perform theu work personelly or through theu own emplayees,without a hcensed contractor or
snbcontrackar,only under lsmited condztrons.
A frequent prachce of unhcensed persons professing to be contrackors is to secure an"owner-
builder" buildutg pernut, erroneonslp unplyiing that the proper#y owner rs providing h�s or her own labor
and matenals pers�killy Buildirtg pernuts are not required to be signed by the praperiy owners unless
they are performutg their own work persanally
Infarntahon abouk hcensed contractars may be obtained by contactrng the Contractors State Iacense
Board at 9821 Btvsiness Park Dnve,Sacramenta,CA 95827,www cslb ca eav or at(800)32I-CSLB {2752)
Please complete and retum the enclosed "C7wner-Budder"venhcat�on form so that we can confrrm
that you are aware of these matters The build�ng pernut will not be�ned unhl the venficahon�s
retumed
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Builc3ing& Safety Diuision
21825 Copley Drive
Diamond Bar,California 9T765
(944}839-702Q Fart{909}$61�3157
Aitenaan Property Owner
An"C7wner-Bu�lder" building permit has been appheti for ut y�vr name and beanng your stgnatut�e
Please complete and return#lus u�formahon at your earhest opporturuty to avoad unnecessary delay rn
processmg and yssumg your buxldmg pemut Na buddmg pernut will be issued unkcl this verificahon is
received by as
1 I persanally plan to provide the u�a�ar Iabor and matenals for conshufit�an of the proposed praperty
impraveme es r na}
Z have have not) signed an apphcatron far a building peraut for the propased work
3 I have contracted wrth the follawulg person(hrm} to provtde the proposed constructron
Name Address City
Phane Contractors License No
4 I plan to prov�de ppxttons of the woxk, 6ut I have tured the followutg persan to coordulate,
sixperv�se and provide the ma�or wark
Name Address City
Phone Cpntrac#ors License No
5 i cvill provide some of the work buk I have contcacted (h�red} the followsng persc�ns to pxavide the
work mdreated
Name Address Phone Type of Wark
Signed
Properly Qwner
Date
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� NQTICE Tf1 PROPERTY OWNER
Dear Property Ownar
An applioation for a building permit has
been submitted in your name listzng
yaurself as the buildar of the property
zmprovements specified at
we are pravzcling you with an Owner-Suslcler
Acknowledgmant anti Information Verifacatzon
Form to make you aware of your
rasgonsibilities and possible rLak you may
incur by having thss permit issued in your
name as the Owner-Huilder
We wzll ncat isaue a building permit until
you have read, ina.tsaled your understanding
of each proviaion, ssgned, and returned
this form to us at our official addreee
indicated
An agent o£ the owner cannat
exacute thzs notice unless you, the
property owner, obtain the grior approval
of the permitting authority
OWNfiR'S ACKNOWLEDGMBNT ANB VERIfiICATION OF
INFOfLMAT20N
DIRECTIONS Read and znztial each statement
below ta szgnsfy you underatand or verify
thza information
�F*t-1 I understand a freguent praatice af
unlicensed persona is to have the property
owner obtain an "Owner-Huzlder" buildsng
permit that erroneously amplies that the
property owner is providsng his or her own
labor and materzal personally I, as an
Owner-Builder, may be held lsable and
sub}ect to eer.vous financial risk for any
in}uries sustained by an unlicensed
person and his ar her employees while
working on my praperty My homeowner�a
insurance may not provide coverage for
those in�uries I am wzllfully acting as an
4wner-Builder and am aware of the limits of
my insurance coverage for znjuries to
warkers on my property
U` �" 2 I understand building permits are
not required ta be signed by property
owners unless they are reapansible for the
construction and ar� not hzring a licensed
Contractor to assume this reaponsibility
�� 3 I understand as an "Owner-Builder"
I am the responsible party af record on the
permit I understand that I may protect
myself from potential fznancial risk by
hsrsng a licensed Cantractor and having th�
permzt filed in his or har name instead of
my own
t ,
' f %J 4 I understand Contractors are
requzred by law ta be licenaed and bonded
, , in Californsa and tp l�st their license
numbers on permits and contracte
�� 5 S understand tf z employ or
otherwisa engage any gersons, other than
Californse licensed Contractors, and the
total value of my canstruction is at least
five hundred dollars {$SOp) , including
labar end materials, I may be conaidereci an
"employer" under state and federal law
�6 I understand if I am considered an
'�emgloyer° under state and federal lew, I
must regieter witfi the etate and fecieral
government, withhold gayrall caxes,
prov�de workers' compensation disability
insurence, and contribute to unemployment
campensation for each "emgloyee " I also
underetand my failure to abide by these
laws may sub�ect me to aerious financial
risk
("�7 I understand under California
Contractors' State L�.cense Law, an Owner-
Buzlder who bualde single-family
residential structures cannot legally buzld
them with the intent to offer them for
sale, unleas all work ss performed by
licensed subcontractorm and tha number of
strucCurea does not exceed four within any
calendar year, or all of the work ie
performed under contract wzth a licensed
general buildsng Contractor
I"�•8 I understand as en Owner-Builder if
I sell the praperty far which thie permit
is i$sued, I may be helcl liable for any
fsnancial or personal in�uriea austained by
any aubsequent owner{a} that result from
any latent constructlon defects in the
workmanahip or materials
/��9 2 understand S may obtain more
infarmatzon regarding my abligations as an
"employer" from the Internal Revenue
Service, the United States Sma11 Husineas
Administratian, the CalifQrnia Degartment
of Henefzt Payments, and the California
Dsvis�.on of Industrial Acozdents I also
understand I may contact the California
Contractors' State Licen&e Baard (CSLH} at
1-800-321-CSLH (2752) or www cslb ca gov
for more snformation about licensed
confiractors
, .
' t 10 I am aware af and consent to an
Owner-auilder building permst applied for
� � zn my name, and understand that I am
the party legally and fznancially
responaible for proposed aonstructson
activity �t the fallowing address
� 11 I agree that, aa the party legally
and financially responeible for this
progosed conatruction actzvity, 2 will
abide by a11 agplicable laws and
reqixirementa that govern Owner-suildera ae
well as emplayers
�' 12. I agree to notify the issuer of
this farm immediately af any additiona,
deletiona, or changes to any oP the
znformation S have provided on this form.
Licensed contractors are regulated by
laws designed to prote�t the public If y�u
contract with someone who doas not have a
license, ths Contractars' State Licznae
Hoard may be unable to asaist you with any
£inancial loss you may eustain as a reault
of a complaint Your only remedy against
unlicensed Contractora may be in civil
caurt Zt is also imgortant for you to
underatand that if an unliceneed Contractor
or employee of that individual or firm zs
in7uzed while wprking on your pr4perty, ypu
may be held liable for damages If you
obtain a permit as Oomer-Huilder and wiah
to hire Contractora, yau will be
responsibla for verifyzng whether or not
thoae Contractora are progerly licensed and
the atatus o£ their workera' compensatian
ineurance coverage
Before a building permit can be issued,
this form muat be complated and signed by
the property owner and returned to the
agency reeponsible for iseusng the permit
Note A copy of the property ocmer�s
driver'a license, form notarization, or
other verification acceptahle tp the agency
is required to be presented when the permit
is issued ta vsrify the property owner's
aignature� ��
ig ature of Propert�
Date � �