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MAYOR <br />Miguel A. Pulido <br />MAYOR PRO ITM <br />Lisa Blst <br />COUNCILMEMETRS <br />Claudla C. Alvar€z <br />Carlos Bustamant€ <br />Albena D. Christy <br />Mik€ Garcia <br />.,ose Solorio <br />Name <br />Addre SS <br />4 <br />CITYMANACER, <br />. <br />Davld N. Ream <br />CITY ATTOTNEY <br />,oscph W. Fletcher. <br />CLERK Of THT COT,I|CIL <br />Patrlcla E. Healy <br />PIANNI}IG & ETJILDII'IC AGTNCY <br />20 Civic Center Plaza o P.O. Box l9EB <br />Santa Ana, California 92702 <br />wtar.Santa-ana.or9 <br />owNER-BUtLDER VERTFTCATION (HSC 19831) <br />Attention Property Owner: <br />An "owner-builder" building permit has been applied for in your name and bearing your signature. <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 verification is received <br />(Read information on Page 2 prior to completion of this form.) <br />1. I personally plan to provide lhe major labor and materials for construction of lhe proposed property <br />improvement (yes or no) <br />CITY OF SANTA ANA <br />City <br />2 ho,n signed an application for a building permit for the <br />3. I have contracled with the following person (firm) to provide the proposed construction <br />I (have/have not) <br />proposed work. <br />Phone Contraclor's License No. <br />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. lwill provide some of the work, but I have contracted (hired) the following persons to provide the work <br />indicated: <br />NAME ADDRESS PHONE TYPE OF WORK <br />Signed: <br />Property Owner (print) <br />Property Address: <br />Dale: <br />7 7a C