HomeMy WebLinkAbout16-0075 _._. CITY OF DIAMOND BAR �
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`'` 218I0 Copley Drive,D�amand Bar,CA 41765 PRESS
. (904)839-7020 Fax:(9U9)861-3117 Buddinglnspechan Hat6ne{909)839-7�2? FIIfiM�Y
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Building &Safety Diuision
21£�SO Coplep Urive
Diarnand Bar,California 91?bS
{9U9}$39-7420 Fax{909}861-5117
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Job Address .'Z..�"`� ��' S U-'rti .�t�'" {�JuS`cv+S.�:�q 1� ,-�' '�4�ttu�D�fY�,@.�� t '�65
Dear Property{}wner
An app6ca#ian for a buddmg permct has been suhm�ted in your narne stating yaurself as the bu�Ider af the
property improvements speafled
For your protection, you shouid be aware that as°owner-bu�lder°you are the respons�ble party of recard on
such a permit Build�ng perm�ts are not requ�red to 6e signed by property owners unless they are personally
perfoRnmg their own warlc ff your work�s be�ng performed by sameone ottrer than yourself, you may prote�t yourself
from �ssibie liab�hty d that persan applres far the proper permd in h�s or her name
Contractors are requ�red by law to be 6censed and bonded hy the State af Cal�fornia and t4 have a business
hcense from the Cdy+ of County They are also requ�red by law ta put thein c�ense num6er on all perm�ts for which they
aPP�Y
If you employ or otherwise engage any persons other than yaur immedtate famdy, and the work{�ncludmg
matenais and other costs� is$200 4Q ar more for the e�fire pro�ect, and such persons are not 6censed as contractors
or su�ntractors,then you may be an employer
!f you are an empioyer, you must reg�ster with the state and federal government as an employer and yc�u are
sub�ect to several obligat�ons mciuding state and federal income tax withhokJinr�, federal sociai security taxes, w4rkers
cornpensation �nsurance, disabiiity insurance casts, and unempiayment campensaban cantribufions
There may be financiai risks for you if you do nat oarry out these flbUgations, and these nsks are espeaally
senous wdh respect ta workers campensation rnsurance
For mare specific informa4an a6out your obligabons under the federal law, corrtact the Internal Rev�ew Service
(�nd d yau w�sh, the U S Small Busmess Admmistration} Foe more specific informa4on about your obligat�ons under
State law, contact the Department of Benefit-Payments and the D�vis�on of IndusVial Accidents
If the structure is intended for saie, the praperty owners who are not hcensed contraCtors are allowed to
perform thefr work personaily c�r through their own ernployees, without a hcensed contractor or subcontractor, oniy
under I�m�ted condit�ons
A frequent practice of uniicensed persans professing to be conUactars is ta secure an "owner-budder"buildmg
permit, erroneous�y implying tFrat the property owner is provttiing h�s or her awn labor and matenals persanaliy
Bu�Ed�ng permtts are not requved to be s�gned by the property owners uNess they are performing their awn work
personaily
Information abaut Iicettsed contractc�rs may be obta�ned by contacting the Contractors State License 8oard at
9$21 Busmess Paric 6nve, Saaeamento, CA 95827, www cslb ca aov or at{800) 821-CSLB (2752)
Ptease complete and retum the enciosed"Owner-Budder"venficat�on farm sa that we can canfirm that you are
aware of these matters The butlding permd wdI nat be issued unnl the venfication �s retumed
. ' '
��
BaiIding &Safei1r Division
21825 Captey Drive
Diamond Baz,California 41765
��}sss-7a2o F�{�}ssr-sl��
Attentron Pr4peRy Ow�er
An "Owner-Budder" budding permrt has been apphed for m your name and L�armg your s�gnature
Pfease complete and return this inFarmatiori at your earl�est opporturnty to avaid unnecessary defay m processing and
issu�ng your buddrng permit h10 butldmg permit wdl be�ssued untii this ver�cation is recerved by us
1 I personally pi n to provide the ma�or labor and matenals far construction of the prcaposed property
improvement y�pr no)
2 1 {have/have not) �A9.a., signed an appbcation for a buttding permit for the proposed wark
t�--
3 I have contract�i w�th the foflowing person{firm)to provide the praposed construcban
Name Address G�ty
Phone Gontractors License No
4 I pian to prov�de port�c�ns of the work, but i have hired the foliowmg person to caord�nate, superv�se and
prov�de the ma}or work
Name Address C�ty
Fhane Gontractors License No
5 I wdl provide some of the wark but I have contracted (hired}the follow�ng persons to pravide the work
indicated
Name Address Phone Type of tMark
SMgned��aMs+,� ��t�A.
Pro rty t)wner
[}8te � ��,��,
. •
NOTICE TO PROPERTY OWNER
Dear Property Owner
An application for a bwlding permit has been submitted in your name listing yourself as the builder of the property
improvements speafied at3$Z�-St��.c�—�n.ass,,�' �I�i
��Amon�D t�Td ,e R 91�►65
We are providmg you with an Owner-Builder Acknowledgment and Information Verification Form to make you aware of
your responsibdities and possible nsk you may incur by havmg this permit issued in your name as the Owner-Bwlder
We wdl not issue a building permit until you have read, mitialed your understanding of each provision, signed, and
returned this form to us at our offiaal 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 ACKNOWLEDGEMENT AND VERIFICATION
DIRECTIONS Read and initial each statement below to signify you understand or venfy this information
1 I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-
uilder' building permit that erroneously implies that the property owner is providing his or her own labor and material
personally I, as an Owner-Bwlder, may be held liable and sub�ect to serious financial risk for any in�uries sustained by
an unlicensed person and his or her employees while working on my property My homeowner's insurance may not
provide coverage for those in�uries I am wdlfully acting as an Owner-Builder and am aware of the limits of my
insurance coverage for in�uries to workers on my property
�2 I understand building permits are not reqwred to be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility
�3 I understand as an "Owner-Builder' I am the responsible party of rewrd on the permit I understand that I may
protect myself from potential financial risk by hinng a licensed Contractor and having the permd filed in his or her name
instead of my own
�4 I understand Contractors are reqwred by law to be licensed and bonded in California and to list their license
numbers on permits and contracts
�5 I understand if I employ or othervvise engage any persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred dollars ($500), includinglabor and materials, I may be wnsidered
an "employer' under state and federal law
�6 I understand if I am wnsidered an "employer' under state and federal law, I must register with the state and
federal government, withhold payroll taxes, provide workers' compensation disabdity msurance, and contnbute to
unemployment compensation for each "employee" I also understand my failure to abide by these laws may sub�ect
me to serious finanaal risk
�7 I understand under California Contractors' State License Law, an Owner-Bwlder who bwlds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is pertormed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is pertormed under contract with a licensed general building Contractor
� 8 I understand as an Owner-Bwlder if I sell the property for which this permit is issued, I may be held liable for
an financial or personal in�uries sustained by any subsequent owner(s)that result from any latent construction defects
in the workmanship or matenals
.�`m}.9 I understand I may obtain more information regarding my obligations as an "employer" from the Internal
' Rev�nue Service, the United States Small Business Admirnstration, the California Department of Benefit Payments,
and the California Division of Industnal Accidents I also understand I may contact the California Contractors' State
License Board (CSLB)at 1-800-321-CSLB (2752) or www csib ca qov for more information about licensed contractors
�10 I am aware of and consent to an Owner-Butlder butlding permit applied for in my name, and understand that I
am the party legally and finanaally responsible for proposed construction activity at the following address
11 I agree that, as the party legally and finanaally responsible for this proposed construction activity, I will abide
b all applicable laws and reqwrements that govern Owner-Builders as well as employers
12 I agree to notiry the issuer of this form immediately of any additions, deletions, or changes to any of the
in ormation I have provided on this fortn Licensed contractors are regulated by laws designed to protect the public If
you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist
you with any finanaal loss you may sustain as a result of a complaint Your only remedy against unlicensed
Contractors may be in avd court It is also important for you to understand that if an unlicensed Contractor or employee
of that individual or firm is in�ured while working on your property, you may be held liable for damages If you obtain a
permit as Owner-Bwlder and wish to hire Contractors, you will be responsible for verirying whether or not those
Contractors are properly licensed and the status of their workers'compensation insurance coverage
Before a bwlding permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for isswng the permit
Note A copy of the property owner's driver's license, form notarization, or other verification acceptable to the agency is
reqwred to be presented when the permit is issued to veriry the property owner's signature
Signature of Property Owne1N^'�`"""� Date � Z �d `�