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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 Contraq2r. , <br />8 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 su bsequent owner(s) that result from any latent construction defects in the <br />workmanship or materials. <br />E-,\-n , 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 wvvw.cslb.ca.oov for more information about Iicensed contractors. <br />[,\,0 <br />the 0arty <br />address: <br />I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am <br />legall and financiall y responsl le for pro construct activity at f lowi <br />-Eu 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 />[ (\,l, <br />' <br />agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the <br />ihfo/mation 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 jndividual or firm is injured while working on your <br />property, you may be held liable for damages. If 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. /Vote: A copv of the propertv owner's driver's license. <br />n anz or ven ation able to the IS ired be ,s <br />issued s,nat re <br />Signature of Property <br />Print name of Owner <br />Owner Date <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 llle the documents necessary to obtain an Owner-Builder Permit for my <br />project. <br />Scope of Construction Project (or Description of Work) <br />Project Location or Address <br />Name of Authorized Agent <br />Address 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: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to <br />be presented when the permit is issued to verify the property owner's signature. <br />i: .f i, ia' a:.r ^:r'i-,,.! r-,::-,-: ;il i r,l:r'. r. p 1;.rlL r': a-r :! ." . <br />SANTA ANA CITY COUNCIL <br />mpulido@sanla ana.oro <br />Mayor Pro Tem, Ward 2 <br />mima.lrnez@santa-ana oro <br />V cente Sarmienro <br />vsamiento@sa.ta-ana.oro isolono@santa ana.ora <br />P Davrd Benavdes <br />dbenavrdeeosanta-ana o.o v eo.s@sz.ta ana oio sl'naie.oaosanta ana oro