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ilfAg t understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Service. the <br />{rdited States Small Business Administration, the California Department of Benelit Payments, and the California Division of lndustrial <br />Accidents. I also understand I may contact the Calilornia Contractors' Stale License Board (CSLB) at 1-800-321-CSLB (2752) or <br />www.cslb.ca.oov for more information about licensed contractors. <br />\\A]!.1 O. I am aware of and consent lo an Owner-Builder building permit applied for in my name, and understand that I am the party <br />-legally and financially responsible for proposed construction activity at the following <br />address: <br />)L\, , 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 govem Owner-Builders as well as employers. <br />N,U\, , agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have <br />provided on this form. <br />Licensed contractors are regulated by laws designed to protect the public. lf you contract with someone who does nothavea license, <br />the Contractors' State License Board may be unable to assist you with any llnancial loss you may sustain as a result of a complaint. <br />Youronly remedy against unlicensed Contractors may be in civil court. lt is also important for you to understand that if an unlicensed <br />Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damag es. lf you <br />obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible for verifying whether or not those Contractors are <br />properly licensed and the status of their workers' compensation insurance coverage. <br />Before a building permit can <br />agency responsible lor issui <br />ed, this form m st be leted and signed by the property owner and returned to the <br />the Note:owner's driver's license form notarization oro <br />I is lssued to ve the owner's <br />sidnature./s /\Signature of Property Owner Date )r- <br />Print name of Owner )llvt c l{1t /L_ <br />AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF <br />Excluding the Notice to Property Owner, 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 perjury 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 />Nots: A copy of ahe owner's driver's license, form notarization, or other yerification acceptable to the agency is required to <br />be presented when the permit is rssued to verify the propefty owner's signature. <br />PLink:\'^iP51 CcunierActrvilyrAssemil yBilis,Notrce to Proler1y Form <br />SANTA ANA CITY COUNCIL <br />mo!l'doasant6-sna d. <br />Matq Pro Tem. Ward 2 <br />mrnra(nezosanl6-3na.o.q <br />v cenle Sarm enlo <br />vsa.m'enio@sa.ta ana o.o Esi.a!9@r!!l&a!!,!!c <br />P Oav,d Eenavdes <br />dbenaed6@santa'a.a.oro <br />t