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//4L, I understand as an owner-Builder if I sell the property for which this permit is issued, I may be hetd liabte for any <br />/ / finahcial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the <br />workmanship or materials. <br />ervice, <br />I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue <br />the United States Small Business Administration, the California Department of Benefit Payments, and the <br />California Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board <br />(CSLB) at 1-800-321-CSLB (2752)or www.cslb.ca.qov for more information about licensed contractors <br />0. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am <br />he arty legally and financially responsible for proposed construction activit y at the following <br />addrcss:7ooq i^.C^hA,- 91. <.^t.?27 ,4 <br />//Z', I agree that, as the party legally and financially responsible for this proposed construction activity, twiu abide by' all applicable laws and requrrements that govern Owner-Builders as well as employers. <br />H4t, I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the <br />' information I have provided on this form. <br />Llcensed contractors are regulated by laws designed to protect the public. lf you contract with someone who does not <br />have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain <br />as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. lt is also important for <br />you to understand that af an unlicensed Contractor or employee of that individual or firm is injured while working on your <br />property, you may be held liable for damages. lf you obtain a permit as Owner-Builder and wish to hire Contactors, you will <br />be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' <br />compensation insurance coverage. <br />Before a building Permit can be issued, this form must be completed and signed by the property owner and <br />returned to the agency responsible for issuing the permit. ,Voter <br />form notarization, or other verification accep table to the agency is required to be Dresented when the permit is <br />issued to verifu the ertv owner's sionature <br />Signature of Property <br />Print name of Owner <br />Owner Date 4-tq-L <br />AUTHORIZ.ATION OF AGENT TO ACT ON PROPERW OWNER'S BEHALF <br />Excluding the Notice to Property O\,vner, the execution of which I understand is my personal responsibility, I hereby authorize the <br />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 <br />project. <br />Scope of Construction Project (or Description of Work) <br />Project Location or Address <br />Name of Authorized Agent: <br />Address of Authorized Agent <br />Phone Number of Authorized Agent <br />I declare under penalty of periury that I am the property owner for the address listed above and I personally filled out the above <br />information and certify its accuracy. <br />Property Owner's Signature Date <br />Print Name of Owner: <br />Note: A copy of the owner's driver's license, form notarization, or other vedfication acceplable to the agency is required to <br />be presented when the Wrmit is issued to verify the propefty owner's signalure. <br />PLink:WP51/Counter Activrty/Assembly Bills/Notrce to Property Form 03-i3-2014 <br />SANTA ANA CITY COUNCIL <br />Mevry A!-16 W3.4 6 <br />ST'.asolasanlz a6a m <br />A^q6r,o &e/o,a , P O6\.n Baaud€s iwiftl , wdil <br /> Ar@oaAsara'rE m i p€sBhd€.6sl3{rE m i RRe!.aAsa^ra a.a c.. <br />l <br />A coDv of the DroDeftv owner's driver's license,