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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 performed under contract with a licensed general building Contractor. &lunderstand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or materials. -& I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors. 4Q-,0.1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party lega address: lly and finan ciall responsible for proposed construction activity at the following -?f 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 govern Owner-Builders as well as employers. Zr.I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. lf you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. lt is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. lf you obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. /Voae:A coDv of the Drooertv owner's license form notarization, or other verification acceDtable to the aqencv is reouired to be pre sented when the permit is issued fo Signature of Property Print name of Owner owner'nature. Owner Date /l) Re?Lht, LtGlrl y'tr tvL4 7-1^n C-)n,a-r'*- AUTHORIZATION OF AGENT TO ACT ON PROPERry OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the 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 project. Scope of Construction Project (or Description of Work)9t"{,+7.10 aD I L<-f 9 NrOt?&twrr 3NrA A cr) Name of Authorized Agent J€Ti ileoOo-"t Address oi Authorized Agent -J F9r uL lL56v-t 7f2-e12-ti-+d (A 621 Date Phone Number of Authorized Agent 1q ZZ-7qoo I declare under penalty of perjury that I am t property owner for the address listed above and I personally fllled out the above information and certify its accura Property Owner's Signature: Print Name of Owner:Ltr*, C)^a-\-t- Note: A copy of the owner's driver's license, form nolarization, or other verification acceptable to the agency is required to be presented when the permil is issued to verify the propefty owner's signalure. SANTA ANA CITY COUNCIL Migue A. Puido Mrchele Martinez Mayo. Mayor P.o Tem, Ward 2 mpurrdo@sanla-anaoro mimanrnezosanla-anaora vicenre samienlo vsa.mlenlo@santa ana oro Jose Solono P. David Benavdes Juan villegas Sa T najerc Ward 3 Ward 4 Ward 5 Ward 6 lsolono@santa ana.oro dbe.avides@sanlasna.oto iv eoas@sa.la-a.a oro slina ero@sanla_ana.ora Project Location or Address: I (647)/, /u e3A