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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 />-ru\. 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 />financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the <br />workmanship or materials. <br />Yfl- g 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 \ryww.cslb.ca.oov for more information about licensed contractors. <br />^tlY&_lO.l am aware of and consent to an OwnerBuilder building permit applied for in my name, and understand that I am <br />' the party legally and frnancially responsible for proposed construction activity at the following <br />ad rESS <br />'11. 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 />4l-- e.l agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the' t - informationi 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. /Vote;f ow ner's driver's license <br />form notarization, or other verification acceptable to the agencv is reouired to be Dresented when the Dermit is <br />,ss <br />Date: t, - tr'r?Signature of Property Owner <br />Print name of Owner <br />Scope of Construction Project (or Description of Work) <br />Project 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 filled out the above <br />information and certify its accuracy. <br />Property Owner's Signature Date <br />Print Name of Owner <br />Note:AcopyoftheW,orotherverificationacceptabtetotheagencyisrequiredlo <br />be presented when the permit is issued to verify the property owner's signature. <br />SANTA ANA CITY COUNCIL <br />moulido@santa-ana.oro <br />Mayor Pro Tem. Ward 2 <br />mrman nezrAsanla ana.oro <br />V'.cnre S.m enro <br />wam'enlorasa.la 6na.oro rsolono@santa-ana oro <br />P Oav,d Benavdes <br />dbenavdesiAsanla ana oro lvilleoas@saol. ana.oro stimiero@sanla ana.oro <br />AUTHORIZATION OF AGENT TO ACT ON PROPERW 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 Owner-Builder Permit for my <br />project. <br />Address of Authorized Agent:_