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SV it 1z.�ZVVV Ja UJ rrtn Lvu-toaaeoa JJlay4VlNIY UG• �yvv<.�vve An application for a buil bas be.�bmitted in name if as tl �P � lit >� y property irrtprovememtt. For you prowaion,you should be aware the as`awner4milder"you are the responsible p uty of mord on such a permit. Building pertdts are not requmd to be signed by property owners unless they arc personally per*ming drum own work. If your work is being performed by someone other than yourself you may protea yourself form possible liability if that person applies for the proper permit in bis or her name. Cowncto s are ted by law to be licensed and bonded by sire State of Callfom*sad may be required to have it business licenn fiats the city or county. They are also required by law to put than license number an all perms far which they apply. If you plan to do your own work,with the exception of various trades that you plan to sub-craattact, you should be aware of the following information for your benefit and protectiew If you enWloy or otlumwise engage any persons other than year in3mediate family, and the work(including materials and other costs) is 5500 or more for the entire project, and such persons are not licensed as contactors or subcontractors, then you may be an employer. U you ata:1111 employer.you naut register with the State and Federal government as an employer and you are subject to several obligations including Stage and Federal incomers tax witbbiold*, Federal social security takes, Worker's Compensation insurance,Disability in4tuance costs, and unemplayumm com*ensation contnIxxtiam. Where may be fmaaacW risks for you if you do not carry out these abligations and these ridm ire especially serious with respect to worker's Coir>peusattion bmrance. For more specific information about your obligations under Federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Bustness Adminisbwvn), For more specific motion about your obligations under State law,the Deparnneiit of Benefit Payments and the Division of Industrial Accidents may be contadod. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform the work personally or through their own amployeea,without a Hcensed>nractor or subconmictor,only under limited conditions. A frequent practice of unlicensed persons professing:to be awractms is to seem an `o nter4nu'ldee' building permit, eaonmaly implying.that the properly owner is personally providing his or her own labor and material. Building permits are not required to be sighed by property owners Walesa they aro personally petfanumi g thou own work. Information_ about licensed conhwtors may be obtained by contactiog the Contractor's Statc License board at 1020"N"Street,Sacramento,CA 95814. The Stage of California Health and Safety Code,Section 19830,Chapter 9, Part 3,Division 13,esquires the permitting agency to malas you aware of these laws and ordininw:s, and requires you to conmplew this foam and return it tea us befbre we may issue your permit: 'Any contractor you list must have his State Contractors LiC=C number and a cruamtt,valid,Certificate of WoriCerr's CompensatiOU hl5U 4WC(or waives)on:fele with the Contractors State Licenug Board If you are hiring someone other shun a sonomotor to do the work,your Worker's Compensation Insurance must be on file in this Departmmemt in the farm of a valid,carrent cerlifcate from your Insurance Agent. Yes or No(Circle one)I personally pleat to provide the major labor and materials for time construction of the proposed improvedumL I have or have not(Circle one)signed an application for a building permit for the proposed orotic. I have',contwied with time folllowing person(firm)to provide the proposed constrerction: Name;&Contractor License Number Address&City ----- - Telephone Number I plan to provide portions of the work,but I have hired the Following person to coordinate,supervise and provide the major work: Nam 1st Contractar L=nsc Number Address&City Telephone Number I will provide some of the work but I have contracted(hired)the following person(s)to provide the work indicated: Name'&contractor License Number Address Ile City&Type of Work Telephone Number Signature of Property Ow +' Mailing Address Location of project site address. (if different frorn above) Telephone Number Date ❑ FILL OUT BOTH SIDES OF THIS FORM IF BOX IS MARKED F-\BV1LtXN 094 OWNER-BUILDMdac(RevisA 9-13-04)