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/!uo,o* <br />) Y MiguelA PulidoI MAYoR PRO TEM <br />Lisa Bist <br />COUNCILMEMEERS <br />Claudla C. Alvarez <br />Cador Bustamante <br />Albena D- Christy <br />Mike Carcia <br />,ose Solorio <br />C]IY MANAGER <br />David N. Ream <br />CITY ATTORNEY <br />Joseph W. Flet(her <br />CLERK Of THE COUNCIL <br />Patricia E. Healy <br />CIry OF SANTA ANA <br />PI-ANNING & BUILDING AGENCY <br />20 Civic Center Plaza . P.O. Box 1988 <br />Santa Ana, California 92702 <br />www.5anta-ana.org <br />owNER-BUTLDER VERIFICATION (HSG 19831) <br />Attention Property Owner: <br />An "owner-builde/ building permit has been applied for in your name and bearing your signalure. <br />Please complete and return this information at your earliest opportunity to avoid unnecessary delay in <br />processing and issuing your building permit. No building permit will be issued until this verificalion is received. <br />(Read information on Page 2 prior lo completion of this form.) <br />'1. I personally plan to provide the major labor and materials for construction of the proposed property <br />improvement, (f6O or no) <br />I (have/have not) <br />proposed work. <br />signed an application for a building permil for lhe <br />t 2o61jso <br />2 <br />3. I have contracted with the following person (firm) to provide the proposed construclion: <br />Name <br />Address City <br />Phone Contractor's License No. <br />4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise <br />and provide lhe major work: <br />Name <br />Address <br />Phone <br />City <br />Contractor's License No <br />5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work <br />indicated: <br />NAME ADDRESS TYPE OF WORK <br />Signed:i%zeazz-o.:Oruzt-<5Property Owner (print): <br />Property Addres <br />Date: €: <br />I t-a- <br />PHONE