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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. OEa f understand 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 owner(s) that result from any latent construction defects in the worknnanship or materials. MU. , understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Smatl 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 4k r.l am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the oartv leoallv and financiallv res aaaiesi,J€45 lNfrT oonsible for orooosed constru'tY1HZ7++ 1A^l€"ltf'ffi*"#flff in.b qT7 6A W_l-l.l 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. .( f(KlZ 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 Iicensed and the status of their workers' compensataon 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. /Vofe.'A coov of the Drooertv np.r's driver's ti cen e_ rization or other table to the enc ,s u ented when the it issued Signature of Property Own C:^*Date I /tr Print name of Owner L A.J AUTHORIZATION OF AGENT TO ACT ON PROPERW 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 Owner-Builder Permit for my project. Project Location or Address Name of Authorized Agent: Address of Authorized nti Phone Number of A orized Agent mpulidorasanta-ana oro Mayor Pro Tem Ward 2 m marlrnez@s6nl. ana.oro Vcente Samrenlo vsamre.to@sa.ta ana oro so oro@santa ana oro P o6vid Benavdes dbenavldes@sanla'ana.oro v,lleoas@saila-a.a oro srrnaEro@sanla-ana oro ScooeofconStructionProiect(oIDeScriptionofWork): / I declare under penalty of perjury that I am the prope(y owner for the address listed above and'l personally lllled out the above information and certify its accuracy .," Dara-Property Owner's Signature: Print Name of Owner . Note: A copy of the owner's driver's l'lrense, form notarization, or other yerification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's.slgnature. ;'', i.'i,: :-..,':.jl'r. . r A.j.!':,a !'..r.. i:t'. i,':, "- a' 1: :/. :' SANTA ANA qTY COUNCIL