HomeMy WebLinkAboutRW110156_Notarized cash bond form, owner builder acknowledgment, notarized agent letter1Ajavi d'Y.
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This agreement is entered into between / eI rfir �. cam` � hereinafter
referred to as "Principal" and the County of Orange, or assigns hereinafter referred to as "County", to
insure the completion of grading required by Grading Permit Application # 1`15
at / PC,i C «S &0, Ale -A' (Y. 4 4 t j �/"i
NOW, THEREFORE, IT IS AGREED that: r1 (0 7
f Principal does herewith post a cash bond in the amount of If 0, dollars for which County
acknowledges receipt
2. a. If Principal complies with all provisions of "the County of Orange Grading and Excavation Code"
Article 8 Division 1 of Title 7 of the Codified Ordinances of the County of Orange, commencing with
Section 7-1-800 thereof; and other applicable laws and ordinances; and
b. Complies with all of the terms and conditions of the permit for excavation or fill to the satisfaction
of Building Official; and
c. Completes all work contemplated under the permit within the time limit specified in the permit, and
any extension or extensions thereof, or completes the work to a safe condition satisfactory to the
Building Official, the cash bond shall be released.
a. If Principal fails to comply with the aforementioned requirements, the Building Official may order
the work required by the permit to be completed or put in a safe condition to his satisfaction.
b. The cash bond shall be used as necessary to pay for the completion of this work. After completion of
the work, any funds remaining in this bond shall be refunded to Principal.
c. If the cost of the work exceeds the amount of this bond, Principal herby agrees to reimburse County
for such excess costs.
d. Principal agrees that if County brings suit to collect for the work contemplated by this permit that
the reasonable attorney's fees as fixed by the Court, shall be paid by the Principal,
*NOTE: "Cash" shall be either cash or Cashier's Check. No personal checks will be accepted.
Date: fe Z,,,z-%
�Pll
ndpa: (NoraMzed Signature)
of California )ss.
ty C o u n uf_ _ )
On
before me,
a Notary Public
personally appeared personally know to me (or proved to me on the basis of
satisfactory evidence) to be the person whose name is subscribed to the within instrument and acknowledged to me that he/she
authorized capacity, and that by hi/her signature on the instrument the person, or the entity upon behalf of which the person acted,
executed the instrument.
WITNESS my hand and official seal.
Signature ofrhe Notary
NOTARYSEAL
PLANNING 1300 N. Flower Street, Santa Ana, GA 92703 1 GRADING PERMIT CASH 6OND FORM I PAGE 24
Owner -Builder Acknowledgment and 3 300 N. Flower Street
Santa And. CA 92703
Information Verification Form r(? 714.667.8888
County of Orange ' I72
..........................................................................................,...............
714.8 4
Q;,ocpCustamerCare®ocpw.00gov.com I www.ocplanning.net
In an effort to protect the citizens of California from unlicensed Contractors taking
advantage of property owners; beginning January 1, 2009 California Assembly Bill 2335
amended the California Health and Safety Code, Section 19825, regarding disclosures
and verifications required for all applicants seeking Owner -Builder construction permits.
These new application requirements provide an enhanced level of consumer awareness
and protection for property owners accepting the risks associated with Owner -Builder
construction permits and will help in slowing the unsafe and illegal construction taking
place in California.
Because of these amendments, the County of Orange is required by State Law to include
in your application documents the necessary forms and disclosures as attached. Before a
permit can be issued you are required to complete and sign these documents pursuant to
the California Health and Safety Code requirements.
PROPERTY OWNER'S PACKAGE
Disclosures & Forms for Owner -Builders Applying for Construction Permits
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.* _ We are providing you with an Owner -Builder Acknowledgment and Information Verification Form 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 reed, initiated your understanding of each
provision, signed, and returned this form to us at Our official address indicated. An agent of the owner cannot execute
this notice unless you, the property owner. obtain the prior approval of the periniging authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
DIRECTION'S Read and initial each stalemenr helow to signify that you understand or verify (his information.
_ l 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. 1,
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.
_ 4- 1. i understand that property owners are not required to sign for building permits as an owner -builder unless they are
resprinsible for the construction and are not hiring a licensed Contractor to assume this responsibility.
3. I understand as an "Ot�ner-Builder" 1 am the responsible party of record on the permit. I understand that t 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.
C 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
G. 1 understand that if I am considered an "employer" under state and federal law, 1 must register with the state and
federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each "employee," I also understand my failure to abide by these laws may subject me to
serious financial risk.
T7. 1 understand that 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.
8. I understand as an Owner -Builder if 1 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.
G' 9. 1 understand that I may obtain more information regarding my obligations as an "employer" from the Internal
Revenue Service. the United States Small Business Administration, the California Department of Benefit Payments, and the
California division of Industrial Accidents. 1 also understand that I may contact the California Contractors' State License
Board (CSLB) at 1-800-321-CSLB (2752) or www.osib.co.gov for more information about licensed contractors.
10. l am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am
the party leg ly and ftna cially res onsible for _ proposed construction activit at the following address:
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Imo' 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
applicable laws and requirements that govern Owner -Builders as well as employers.
k 12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information
have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not have a license, the Contractors' State License Board may he unable to assist you with any financial
loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is
also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while
working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire
Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of
their workers' compensation insurance coverage.
Before a building permit cart be issued, this form must be completed and signed by the property owner and returned
to the agency responsible fur issuing the permit. N'otv:.4 copy of the property owner's driver's license, form notarization.
or other verification arceprahle to the agency is required to he presented when the permit is issued to verify Ike property
onrner'.% xignalure.
Signature ol'proper[� ,e er Date:
Niue: The fallowing Authorization Form is required to be completed by the properly owner only when
desi�narin,s; an agent of the property owner to applt� fear a construction permit for the (hvner-Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an
Owner -Builder Permit for my project.
Scope of Construction Project (or Description of Work): ! tM L , RML AOO JN4e WAUo6
Project Location or Address: ) .,
Name of Authorized Agent: . �' !�( __,_Tel No _14+e_mar—+=J
Address of Authorized Agenr. '%'S'M �l _� _c___.. '
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the
above information and certify its accuracy. Note- A cony ofthe owner's driver's license, form notarization, or other
verification acceptable to the agency is required to he presented when the permit is issued to verify the property owner's
signature
Properly Owner's Sign are: EE��L _Date: -
e%A1 lignaNIe ALL-PURPOSE ACKNOWLEDGMENT
CIVIL CODE § 1189
State of California
County ofiiZl -C -
t
pn[>—�before me, Z-'
fat A Here Insert Nflme and Title of thelofficer
personally appeared
ALLY50N E. LANE
Commission +It 1943332
Z Notary Public - California
Orange County
MY Comm. Expires Aug1, 2015
of Slgnans)
who proved to me on the basis of satisfactory
evidence to be the personN whose nameN is/ar4Q
subscribed to the within instrument and acknowledged
to me that he/the/thay executed the same in
his/i aUtNir authorized capacity*), and that by
hisflw, Nir signature(N on the instrument the
person(), or the entity upon behalf of which the
person(N,acted, executed the instrument.
I certify under PENALTY OF PERJURY under the
laws of the State of California that the foregoing
paragraph is true and correct.
WITNESS my hand and official seal.
Si natur J
Place Notary Seal Above g Signature of Not "ic
OPTIONAL
Though the information below is not required by law, it may prove valuable to persons relying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
Title or Type of Docu ent: eV ,an ex 1 i cc� i iD F6-r-rel
Document Date: Number of f ages:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Si ner(s)
Signer's Name:�!eVZ4
❑ Corporate Officer — Title(s):
Individual
❑ Partner — ❑ Limited —i-1 General Top of thumb here
1-1 Attorney in Fact
❑ Trustee
Guardian or Conservator
1 Other:
Signer Is Representing:
CW 2010 National Notary Associatlon • NationalNotary.org - -ow-tea .� v �•
Signer's Name: _
1-1 Corporate Officer — Title(s):
Individual
❑ Partner — I Limited '-j General Top of thumb here
❑ Attorney in Fact
❑ Trustee
❑ Guardian or Conservator
❑ Other:
Signer Is Representing:
Item #5900