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OWNER/BUILDER VERIFICATION FORM (NO PLANS REQUIRED) =Ac -10►. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 1810 E. HAZELTON AVENUE,STOCKTON CA 95205 BUSINESS PHONE: (209)468-3121 INSPECTION REQUEST-24 HOUR RECORDER:(209)468-3165 IMPORTANT! NOTICE TO PROPERTY OWNER Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at_Q t ':500 A tJ O (N)AD A CA m We are providing you with an Owner-Builder Acknowledgment and Information Verification f=orm to make you aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We will NOT issue a building permit until you have read, initiated your understanding of each provision, signed, and returned this form to us at our official address indicated. A copy of the property owner's identification is required to verify the owner's signature. Read and initial each statement below to signify you understand or verify this information. `�; I understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner- Builder'building permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries 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 injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. I understand as an-Owner-Builder" I am the responsible party of record on the permit. I understand that may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. __4. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on permits and contracts. *_�_5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors. and the total value of my construction is at least five hundred dollars($500), including labor and materials, i may be considered an "employer"under state and federal law. I understand if I am considered an "employer'under state and federal law. I must register with the state and federal government, withhold payroll taxes, provide workers'compensation disability insurance, and contribute to unemployment compensation for each '-employee." 1 also understand my failure to abide by these laws may subject me to serious financial risk. 4— 1 understand under California Contractors' State license Law, an Owner-Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. I understand as an Owner-Builder if I sell the property for which this permit is issued. I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. $49: 1 understand I may obtain more information regarding my obligations as an 'employer"from the Internal F:18UILDINGtHAND0UTS.0N-mer Builder Verification Fonm.doc 1 of 2 (Revised 2-27-09)