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MAYOR F CITY MANAGER <br /> Miguel A. Pulido 14" David N. Ream <br /> MAYOR PRO TEM ° `�`. ;: CITY ATTORNEY <br /> Claudia C.Alvarez °°•�• �� -` Joseph W. Fletcher <br /> COUNCILMEMBERS CLERK OF THE COUNCIL <br /> P. David Benavides _ Patricia E. Healy <br /> Carlos Bustamante <br /> Michele Martinez <br /> Vincent F.Sarmiento <br /> Sal Tinajero CITY OF SANTA ANA <br /> PLANNING do BUILDING AGENCY <br /> 20 Civic Center Plaza • P.O. Box 1988 <br /> Santa Ana,California 92702 <br /> www.santa-ana.org <br /> OWNER-BUILDER VERIFICATION (HSC 19831) <br /> Attention Property Owner: <br /> An "owner-builder' building permit has been applied for in your name and bearing your signature. <br /> Please complete and return this information at your earliest opportunity to avoid unnecessary delay in <br /> processing and issuing your building permit. No building permit will be issued until this verification is received. <br /> (Read information on Page 2 prior to completion of this form.) <br /> 1. I personally plan to provide th major labor and materials for construction of the proposed property <br /> improvement (yes or no) +� <br /> 2. 1 (have/have not) -����r,-' =-; signed an application for a building permit for the <br /> proposed work. <br /> 3. 1 have contracted with the following person (firm) to provide the proposed construction: <br /> Name <br /> Address City <br /> Phone Contractor's License No. <br /> 4. 1 plan to provide portions of the work, but I have hired the following person to coordinate, supervise <br /> and provide the major work: <br /> Name <br /> Address City <br /> Phone Contractor's License No. <br /> 5. 1 will provide some of the work, but I have contracted (hired) the following persons to provide the work <br /> indicated: <br /> NAME ADDRESS PHONE TYPE OF WORK <br /> Signed: - �------ .._- —�-- <br /> Property Owner (print): .��� �-✓ - �1 �� <br /> Property Address: <73 <br /> Date: L� -' ' <br />