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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 />I R S. I understand as an Owner-Builder if I sell the property for',ivhich this permit is issued, I may be held liable for any <br />finan'cial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the <br />workmanship or materials. <br />1R-5. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue <br />Servibe, 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 lwvw.cslb.ca.oov for more information about licensed contractors. <br />-rJ. t <br />1nEEl't <br />0 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am <br />ly and financially responsible for proposed construction activity at the following <br />add ress <br />_11.1 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 />12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the <br />information 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 indivldual 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 />com pensation 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. ivote.'owner's driver's licens <br />form notarization, or other tion acceDtable to the aaencv is required to be when the oermit is <br />the s nature <br />Signature of Property O b <br />Print name of Owner v c> <br />AUTHORIZATION 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 />Address of Aulhorized Aoent: <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 Illled out the above <br />information and certify its accuracy. <br />Date <br />Print Name of Owner <br />Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to <br />be presenled when the permit is issued to verify lhe property owner's signature.:.':':|...: <br />SANTA ANA CITY COUNCIL <br />Jose Solono <br />mp!lldo@santa ana.orc <br />Mayor Pro Tem, Wa.d 2 <br />mrmarl nez@santa-ana oro <br />Vicente Samienlo <br />vsarmientolasanla ana oro so oro@sanla-a.a oro <br />P Oavid Benavrdes <br />dbe.avides@santa-ana oro iv eoas@sanla-ana oro stinaiero@sanra-ana.oro <br />Proiect Location or Address: <br />Name of Authorized Agent: _ <br />Property Owner's Signature: