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application for a building permit has been submitted in your name list- SAN JOAQUIN COUNIY NUILDINh INSPECII014 DIVISION yourself as builder of the property improvements specified. 1810 E. liaxelton Ave. , Stockton, CA 95205 1 r your protection, you should be aware that as "owner-builder" you are the REQUIREMENT OF STATE OF CALIFORNIA HEALTH & SAFETY CODE, Sec. 19830 sponsible party of record on such a permit. Building permits are not re- ired to be signed by property owners unless they are personally performing OWNER-BUILDER VERIFICATION eir own"work. If your work is being performed by someone other than your- Attention Property Owner: :If, you may protect yourself from possible liability if that person plies for the proper permit in his or her name. An "owner-builder" building permit has been applied for in your name and •ntractors are required by law to be licensed and bonded by the State of bearing your signature. Please complete and return this information to ,lifornia, and may be required to have a business license from the city or avoid unnecessary delay in processing and issuing your building permit. -Linty. They are also required by law to put their license number on all No building permit will be issued until this verification is received. :rmits for which they apply. 1. I personally plan to provide the major labor and materials for the i you plan to do your own work, with the exception of various trades that construction of the proposed property improvement (Yes or No) .W plan to sub-contract, you should be aware of the following information .r' 2. I (have/have not) signed an application For a building your benefit and protection: r you employ or otherwise engage any persons other than your immediate fam• Permit for the propose work. iy, 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 nm entire project, and such persons are not licensed as contractors or sub- proposed construction: entraetors, then you may be an employer. , Name Phone f you are an employer, you must register with the State and Federal govern- ,nt as an employer and you are subject to several obligations including Address tate and Federal intone tax withholding, Federal social security taxes, :jrkers' Compensation insurance, Disability insurance costs, and unemployment City Contractor's License No. oinpensation contributions. here may be financial risks for you if you do not carry out these obligations 4. 1 plan to provide portions of the work, but 1 have hired the following Ind these risks are especially serious with respect to Workers' Compensation person to coordinate, supervise and provide the major work: nsurance . Mame Phone ,or more specific Information about your obligations under Federal law, con- act t;he Internal Revenue Service (and, if you wish, the U.S. Small Business Address 'administration). For more specific information about your obligations under tate law, the Department of Benefit Payments and the Division of Industrial City Contractor's License No. kccidents may be contacted It the structure is intended for sale, property owners who are not licensed S. 1 will provide some of the work but I have contracted (hired) the contractors are allowed to perform their work personally or through their own following persons to provide the work indicated: .employees, without a licensed contractor or subcontractor, only under limited Name Address Phone Type of Work :onditions. k frequent practice of unlicensed persons professing to be contractors is to secure an "owner-builder" building permit, erroneously implying that the .)roperty owner is providing his or her own labor and material personally. iuilding Permits are not required to be signed by property owners unless they ,re 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 Ilealth and Safety Code, Section 19830, Chapter 9, Signed , Property Owner k, 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 Mailing Address City us,.�.efore we may issue your permit. r Any contractor you list must have his State Contractors License number on Location of Building to be Done File in this Department, and a current, valid Certificate of Workers' Com- pFnsation Insurance (or waiver) also on file in this Department Social Security Number Date _ ._.I_f�you=ar.e=hi.ri-ng=someone—other.:than__a_contractor_.to_do_.the_wor.k.,_yaur= _ =,REQUIREMENT=.OF=TNE=STATE-OF-.CAL.LFORN.IA-:IIEAL.T:M 6-SAFETY-_CODE,._SEC.LI.ON.=1.9830._— Workers' Compensation Insurance must be on file in this Department in the form of a valid current certificate from your Insurance Agent. .G