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An application for a building permit has been submitted in your name list- SAN JOAQUIN COUNTY BUILDING INSPECTION DIVISION <br /> ing yourself as builder of the property improvements specified. 1810 E. Hazelton Ave., Stockton, CA 95205 <br /> For your protection, you should be aware that as "owner-builder" you are the REQUIREMENT OF STATE OF CALIFORNIA HEALTH & SAFETY CODE Sec. 19830 <br /> responsible party of record on such a permit. `Building permits are not re- ' <br /> quired to be signed by property owners unless they are personally performing OWNER-BUILDER VERIFICATION <br /> their own work. If your work is being performed. by someone other than your- Attention Property Owner: 0 <br /> self, you may protect yourself from possible liabijity if that person <br /> applies for the proper permit in his or her name. An "owner-builder" building permit has. been applied for in your name.and <br /> Contractors are required by law to be licensed and bonded by the State of bearing your signature. Please complete and return this information to <br /> California, and may be required to have a business license from the city or avoid unnecessary delay in processing and issuing your building permit. <br /> county. They are also required by law to put their license number on all No building permit will be issued until this verification is received. <br /> permits for which they apply. <br /> 1. 1 personally plan to provide the major labor and materials for the <br /> If you plan to do your own work, with the exception of various trades that construction of the proposed property improvement (Yes or No) <br /> you plan to subcontract, you should be aware of the following information <br /> for your benefit and protection: 2. 1 (have/have not) signed an application for a building <br /> If you employ or otherwise engage any persons other than your immediate fam- permit for the proposed work. <br /> ily, and the work (including materials and other costs) is. $200 or more for 3. 1 have contracted with the following person (firm) to provide the <br /> the entire project, and such persons are not licensed as contractors or sub- proposed construction: <br /> contractors, then you may be an employer. <br /> If you are an employer, ou must register with the State and Federal Name Phone <br /> y y g govern- <br /> ment as an employer and you are subject to several obligations including Address <br /> State and Federal income tax withholding, Federal social security taxes, <br /> Workers' Compensation insurance, Disability insurance costs, and unemployment City Contractor's License No. <br /> compensation contributions. <br /> There may be financial risks for you if you do not carry out these obligations 4. 1 plan to provide portions of the work, but I have hired the following <br /> and these risks are especially serious with respect to Workers' Compensation person to coordinate, supervise and provide the major work: <br /> Insurance . <br /> For more specific information about your obligations under Federal law, con- Name Phone <br /> tact the Internal Revenue Service (and, if you wish, the U.S. Small Business Address <br /> Administration). For more specific information about your obligations under <br /> State law, the Department of Benefit Payments and the Division of Industrial City Contractor's License No: <br /> Accidents may be contacted <br /> 'r,} If the structure is intended for sale, property owners who are not licensed 5. 1 will provide some of the work but I have contracted (hired) the <br /> contractors are allowed to perform their work personally or through their own following persons to provide the work indicated: <br /> employees, Without a licensed contractor or subcontractor, only under limited <br /> conditions. Name Address Phone Type of Work <br /> A frequent practice of unlicensed persons professing to be contractors is to <br /> secure an "owner-builder" building permit, erroneously implying that the <br /> property owner is providing his or her own labor and material personally. <br /> Building Permits are not required to be signed by property owners unless they <br /> are performing their own work personally. <br /> Information about licensed contractors may be obtained by contacting the <br /> Contractors' State License Board at 1020 "N" Street, Sacramento, CA 95814. <br /> The State of California Health and Safety Code, Section 19830, Chapter 9, �C gigned , PropertyOwner <br /> Part 3, Division 13, requirL-s us to make you aware of these laws and ordi- �` <br /> nances, and requires you to complete the form on the right and return it to Mailing Address City <br /> us before we may issue your permit. <br /> Any contractor you list must have his State Contractors License number on Location of Building to be Done <br /> file in this Department, and a current, valid Certificate of Workers' Com- <br /> pensation insurance (or waiver) also on file in this Department Social Security Number Date <br /> If you are hiring someone other than a contractor to do the work, your <br /> Workers' Compensation Insurance must be on file in this Department in the REQUIREMENT OF THE STATE OF CALIFORNIA HEALTH & SAFETY CODE, SECTION 1.9830 . <br /> form of a valid, current certificate from your insurance Agent. <br />