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licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is <br />performed under contract with a licensed general building Contractor. <br />&lunderstand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any <br />financial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the <br />workmanship or materials. <br />-& I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue <br />Service, 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 />4Q-,0.1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am <br />the party lega <br />address: <br />lly and finan ciall responsible for proposed construction activity at the following <br />-?f I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by <br />all applicable laws and requirements that govern Owner-Builders as well as employers. <br />Zr.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 />Licensed 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 if 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. /Voae:A coDv of the Drooertv owner's license <br />form notarization, or other verification acceDtable to the aqencv is reouired to be pre sented when the permit is <br />issued fo <br />Signature of Property <br />Print name of Owner <br />owner'nature. <br />Owner Date /l) <br />Re?Lht, LtGlrl y'tr tvL4 <br />7-1^n C-)n,a-r'*- <br />AUTHORIZATION OF AGENT TO ACT ON PROPERry 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 flle the documents necessary to obtain an OwnerBuilder Permit for my <br />project. <br />Scope of Construction Project (or Description of Work)9t"{,+7.10 aD I L<-f <br />9 NrOt?&twrr 3NrA A cr) <br />Name of Authorized Agent J€Ti ileoOo-"t <br />Address oi Authorized Agent -J F9r uL lL56v-t 7f2-e12-ti-+d (A 621 <br />Date <br />Phone Number of Authorized Agent 1q ZZ-7qoo <br />I declare under penalty of perjury that I am t property owner for the address listed above and I personally fllled out the above <br />information and certify its accura <br />Property Owner's Signature: <br />Print Name of Owner:Ltr*, C)^a-\-t- <br />Note: A copy of the owner's driver's license, form nolarization, or other verification acceptable to the agency is required to <br />be presented when the permil is issued to verify the propefty owner's signalure. <br />SANTA ANA CITY COUNCIL <br />Migue A. Puido Mrchele Martinez <br />Mayo. Mayor P.o Tem, Ward 2 <br />mpurrdo@sanla-anaoro mimanrnezosanla-anaora <br />vicenre samienlo <br />vsa.mlenlo@santa ana oro <br />Jose Solono P. David Benavdes Juan villegas Sa T najerc <br />Ward 3 Ward 4 Ward 5 Ward 6 <br />lsolono@santa ana.oro dbe.avides@sanlasna.oto iv eoas@sa.la-a.a oro slina ero@sanla_ana.ora <br />Project Location or Address: <br />I (647)/, /u e3A