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application fur a building permit has been submitted in your name list- SAN JOAQUIN COUNTY BUILDING INSPECTION DIVISION f " 11 yourself as builder of the property improvements specified. 1810 E. Hazelton Ave., Stockton, CA 95205 your prutection, you should be aware that as "owner-builder" you are the ponsible party of record on such a permit. Building permits are not re- REQUIREMENT OF STATE OF CALIFORNIA HEALTH & SAFETY CODE, Sec. 19830 red to be signed by property owners unless they are personally performing OWNER-BUILDER VERIFICATION :ir=,own work. If your work is being performed by someone other than your- f, .yoa may protect yourself from possible liability if that person Attention Property Owner: lies for the proper permit in his or her name. the State of An "owner-builder" building permit has been applied for in your name and tractors are required by law to be licensed and bonded byour ifornia, and may be required to have a business license from the city or avoidunnecessary delay inlprocease complete and return this information to nty• They are also required by law to put their license number on all No building y y processing and issuing your building permit. nits for which they apply, g permit will be issued until this verification is received. you plan to do your own work, with the exception of various trades that 1. I persona Ian to provide the major labor and m s for the Plan to sub-contract, you should be aware of the following information cons zon. o the roposed property improvemen Yes No) t/ s your benefit and protection: 2. have/ not? �� signed an application for a building You employ or otherwise engage any persons other than your immediate fa per or the proposed work. and the work (including materials and other costs) is $200 or more for 3- I have contracted with the following person (firm) to provide the entire project, and such persons are not licensed as contractors or sub- roposed construction: 'tractors, then you may be an employer. j jou are an eniployer, you must register with the State and Federal govern- Name Phone /� s as an employer and you are subject to several obligations including to and Federal income tax withholding, Federal social security taxis, Address <ers' Canpensation insurance, Disability insurance costs, and unemployment sensation contributions. City -Contractor's Lic7-se No. -0 may be financial risks for you if you do not carry out these obligations 4. 1 plan to provide port' ns of the work, but.-I" have hired the following these risks are especially serious with respect to Workers' Compensation person to coordinate, su rvise and provide the major work: Trance . more specific information about your obligations under Federal law, con- Name Phone the Internal Revenue Service (and, if you wish, the U.S. Small Business inistration) For more specific information about your obligations under Address -e law, the Department of Benefit Payments and the Division of Industrial idents may be contacted City Contra or's License Na. .:he structure is intended for sale, property owners who are not licensed 5, 1 will provide some of the work but I have ontracted (hired) the Tractors are allowed to perform their work personally or through their own following perso "to provide the work indica d: .:ogees, without a licensed contractor or subcontractor, only under limited litians. Name Address Pho Type of Work equent practice of unlicensed persons professing to be contractors is to ire an. "Owner-builder" building permit, erroneously implying that the .erty ownee:'Vs providing his or her own labor and material personally. Iding Permits are not required to be signed by property owners unless they performing their own work personally. �rmation about licensed contractors may be obtained by contacting the .ractors' State License Board at 1020 "N" Street, Sacramento, CA 95814. ' State of California. Health and Safety Code, Section 19830, Chapter 9, 3, Division 13, requires us to make you aware of these laws and ordi- Signed , Property Owner ,es, and requires you to complete the form on the right and return it to k / -efore we may issue your permit. Mailing Address eo S 104r/� X04 City b contractor you list must have his State Contractors License number on Location of Building to be Done ." .� . S.`n ' in this Department, and a current, valid Certificate of Workers' Com- ` r 5k, c �n ation insurance (or waiver) also on file in this Department p Social al Security Number_� (� pate ou are hiring someone other than'a contractor to do the work, your 'ars' Compensation Insurance must be on file in this Department in the REQUIREMENT OF THE STATE OF CALIFORNIA HEALTH & SAFETY CODE, SECTION 19830 orf a valid, current certificate from your Insurance Agent. r¢