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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 />Z <br />fi na ncta <br />. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any <br />I or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the <br />f/t /z.rr <br />workmanship or materials. <br />/ LrB. I understand lmayobtain more information regarding myobligations as an "employer'' from the Internal Revenue <br />S6rVide, 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 informalion about licensed contractors. <br />),GlO I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am <br />the party legally and financially responsible for proposed construction activity at the following <br />address: <br />2 {^ll I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by <br />all apblicable laws and requirements that govern Owner-Builders as well as employers. <br />=hlZ.l agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the <br />ii-forniation 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. Nofe.' A copv of the propertv owner's driver's license. <br />notarization or other verification table to the en ts when the it is <br />th owner's natu <br />Signature of Property <br />Print name of Owner ,,h c:Lt t 6€4^4 <br />Owner Date <br />-JAUTHORIZATION 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 />POect Location or Address <br />Name 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 ,illed 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 driyer's license, form notarization, or other verification acceptable to the agency is required to <br />be presented when the permit is issued to verify the propeiy owner's signature. <br />. i-,r,!: t,-i:i :1-, ly !.:j.,:.: _i:: .. r.-. -. i. rr :r',_ | . - : :' ;..' a <br />SANTA ANA CITY COUNCIL <br />moulido@sants-ana oro <br />Mayor Prc Teh. ward 2 <br />mimarlrnez@santa-a.a o.o <br />V cente Sam ento <br />vsam ento@santa aoa.oro isoloriolosanta-ana.oro <br />P. DBvrd Be.avides <br />dbe.avides@sanla ana oro srnarero@sa.la-ana orovrl eoasiasa.la-ana oro <br />Address of Authorized Agent: