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B25-0073 - 26111 VIA MONTEREYFINAL07/28/2025 OWNER/BUILDER DEVELOPMENT SERVICES Building and Safety PROPERTY OWNER'S PACKAGE [Disclosures and Forms for Owner-Bullclers Applying for Construction P91'1111ts] IMPORTAND NOTICE JO PROPERTY OWNER Dear Property Owner: An application for a building pennit has been submitted in your name listing yourself as the builder of the property improvements specified at ~ I V, Mo" ~ .~ 1'11 i 1 We are providing you with an Owner-Builder Acknow edgment and Vertflcation of Information 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 wlll not Issue a buHclng pe; n,lt until you have reacl. lnltlaled your understanding of each provision, signed, and returned this form to us at our offtclal acldress Indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the pennitting authority. OWNER-BUILDER ACKOWLEDGMENT AND VERIFICATION OF INFORMATION Please read and initial each statement below to signify you understand or verify this information. ~ 1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an Owner-Builder building pennit 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. ~f 2. I understand building pennits 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. ~3. I understand as an Owner-Builder I am the responsible party of record on the pennit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the pennit flied in his or her name instead of my own. ~ 4. I understand Contractors are required by law to be licensed and bonded In Califomla and to 11st their license numbers on pennits and contracts. ~ 5. I understand if I employ or otherwise engage any persons, other than Califomla licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be n I considered an •employer" under state and federal law. ~ 6. 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 Jw to unemployment compensation for each •employee: I also understand my failure to abide by these laws may subject me to serious financial risk. 7. I 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 fi _ i year, or all of the work is performed under contract with a licensed general building Contractor. ~ 8. 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. REV 08/29/24 PAGE 1 of2 USA PASSPORT 567191810 PROPERTY OWNER'S PACKAGE bL 9. 1 understand I may obtain more Information regarding my obligations as an •employer-from the Internal ~ Revenue Service, the United States Small Business Administration, the Califomla Department of Benefit Payments, and the Callfomla Division of Industrial Accidents. I also understand I may contact the California Contractors' State license Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. ~ 1 o. I am aware of and consent to an Owner-Builder bulldlng permit applied for In my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: ~ 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. I ,( 12. I agree to notify the issuer of this fonn immediately of any additions, deletions, or changes to any of the ~ information I have provided on this fonn. 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 be 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 indMdual or finn is injured while working on your property, you may be held liable for damages. If you obtain a pennit 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. Further, JOU are aclvlsed that uch conbador or subcontractor must have a current and valid City of San Juan Capistrano business lcense In order to perfo.11, .-Olk In the City and in which we may ask you to 'W& lfy. Before a building pea mlt can be issued, this form must be completed and signed by the property owner and retumed to the agency responsible for Issuing the permit. NOTE: A copy of the property OMJen dd1nrs license, form notarization, or other verification acceptable to the agency is required to be pres:enll!d Wl~ the ~it ls Issued to Verify the property owner's signature. PROPERTY OWNER s1GNATURE ----",;:::=r-+-i::::P."'"'--------+-~~~~~-=-----DATE 4 h 0 (~s NOTE: The following Authorization is requi to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner-Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Exduding 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 _-:C_n_f_U_,_· o_r---'-~--e'-MoJ_....;::vi,:...;;\ ________ _ PROJECT LOCATION OR ADDRESS 'Ue,\l( \/ i-.. t-1o"f«""j I SaA. -::J' c)," C"pi9f r~"' • °' 9-ZG,15 AUTHORIZEDAGENTNAME frA-\J4 ,.. Cve:,""; "' PHONE (tJ:>-i -'f">'-1-17 '-45 AUTHORIZED AGENT ADDRESS )5 :C"dc 10 u.-., 1 9 .. ~... Po;"./ CA GJ-Z.,1.'\ 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 copy of the owner's driver's Ileen~ form notcrrfmtfofi, or otfter w.llkWJtlon accepmble to the agency Is required to be presented when the penn,;lt Is ued to verify the property 01111en slgnotute. PROPERTYOWNERSIGNATURE ~ _f24 ~-DATE 't[te,f-z...5 REV 08/29/24 PAGE2of2 From:Adams-Handy, Grace To:ali@alijaberarch.com Cc:Marti, Pablo; engcounter; Building Department Subject:Sanitation Clearance - 26111 Via Monterrey - Remodel - SJC Date:Friday, March 21, 2025 10:00:21 AM [The e-mail below is from an external source. Please do not open attachments or click links from an unknown or suspicious origin.] Good Morning, Address 26111 Via Monterrey, San Juan Capistrano has been cleared by SMWD. There are no impacts to public water and sewer Best Regards, Grace​​​​ Adams‑Handy Engineering Technician M: 949-540-5342 smwd.com ***** Please note that email correspondence with the City of San Juan Capistrano, along with attachments, may be subject to the California Public Records Act, and therefore may be subject to disclosure unless otherwise exempt.