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MAYOR <br />Miguel A. Pulido <br />MAYOR PRO TEM <br />Claudia C. Alvarez <br />COUNCILMEMBERS <br />P, David Benavid€s <br />Carlos Bustamante <br />Michele Maninez <br />Vincent F. Sarmiento <br />SalTinajero <br />CITY MANAGER <br />David N. Ream <br />CITY ATTORNEY <br />Joseph W. Fletcher <br />CLERK OF THE COUNCIL <br />Patrlcia E. Healy <br />CITY OF SANTA ANA <br />PLANNINC & EUILI)NG AGENCY <br />20 Civic Center Plaza . P.O. Box 1988 <br />Santa Ana, California 92702 <br />www-5aota-ana.or9 <br />owNER-BUTLDER VERTFTCAT|ON (HSC 19831) <br />Attention Property Owner: <br />An "owner-builde/' building permit has been applied for in your name and bearing your signature. <br />Please complete and return this information at your eadiest opportunity to avoid unnecessary delay in <br />processing and issuing your building permit. No building permit will be issued until this verification is received <br />(Read information on Page 2 prior to completion of this form.) <br />1. I personally plan to provide the major labor and materials for construction of the proposed property <br />improvement (yes or no)a<5 <br />2. I (have/have not) <br />proposed work. <br />/a-o signed an application for a building permit for the <br />3. I have contracted with the following person (firm) to provide the proposed construction <br />Name <br />Address <br />Phone <br />City <br />4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise <br />and provide the 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 PHONE <br />Property Owner (print) <br />Property Address 2o2. tt, P";,f,[ <br />Date: 8-2G'Og <br />Contractor's License No. <br />ADDRESS TYPE OF WORK <br />Signed: