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0 FILL OUT BOTH SIDES IF CHECKED HERE An application for a building permit has been submitted in your name list- ing yaurseif as builder of the property improvements specified. For your protection, you should be aware that as "owner -:builder" you are the responsible party of record on such a permit. Building permits are not re- quired to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than your- self, you may protect yourself from possible liability if that person applies for the 'proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California, and may be required to have a business license from the city or county. They are also required'by law to put their license number on all permits for which they apply. If you pian to do your own work, with the exception of various tradesthat you plan to sub -contract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate fam- ily, and the work (including materials and other costs) is $200 or more for -the entire project, and such persons are not licensed as contractors or sub- contractors, then you may be an employer. If you are an employer, you must .register with the State and Federal govern- ment as an employer and you are subject to several obligations including State and Federal income tax withholding, Federal social security taxes, Workers' Compensation insurance, Disability insurance costs, and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations and these risks are especially serious with respect to Workers' Compensation Insurance . For more specific information about your obligations under Federal law, con- tact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State law, the Department of Benefit Payments and the Division of Industrial Accidents may be contacted If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner -builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building Permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the, Contractors' State License Board at 1020 "N" Street, Sacramento, CA 95814. The State of California Health and Safety Code, Section 19830, Chapter 9,- Part.3, Division 13, requires us to make you aware of these laws and ordi- nances, and requires you to complete the form on the right and return it to us before we may issue your permit. Any contractor you list must have his State Contractors License number on file in this Department, and a current, valid Certificate of Workers' Com- pensation Insurance (or waiver) also on file in this Department If you are- hiring someone other than a contractor to do the work, your Workers' Compensation Insurance must be on file in this Department in the form of a valid, current certificate from your Insurance Agent. SAN JOAQUIN COUNTY BUILDING INSPECTION DIVISION 1810 E. Hazelton Ave., Stockton, CA 95205 REQUIREMENT OF STATE OF CALIFORNIA HEALTH & SAFETY CODE, Sec. 19830 OWNER -BUILDER VERIFICATION Attention Property Owner: An "owner -builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for the t````he construction.of the proposed pr perty improvement (Yes or No) I (have/have not) ��-GIIJ signed an application for a bui ding permit for the proposed work. 3. 1 have contracted with the following person (firm) to provide the proposed construction: Name Addr City Phone Contractor's License No. 4. 1 plan -to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Narie Ci Phone Contractor's License No. 5. 1 will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work Si gned L,;�G� Cr7t�/ .��1�' , Prroope-rtty`Owner Mailing Address G/ /6 �0 "t SL City �JL _k- y/7 �S Location of Building to be //Done��(sl S, �� / Social Security Number � Date 2%%�_4 REQUIREMENT OF THE STATE OF CALIFORNIA HEALTH & SAFETY CODE, SECTION 19830