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M, , ,undersland as.an Of,ner-Builder if I sell the prop€rry for shich this permit is issued, I may be hetd tiabte for any <br />Fnlncial or personal injuries sustained by any subsequent owner(s) that result from any latent consiruction def€cts in thj <br />riorkmanshrp or materials.A,I <br />-ffi| I ulge.rsta( I may obtain more information regarding my obligations as an 'employet. from the lntemal Revenueggt{re, th_e Unrted Statas Small Business Administration, the California oepartment of Benifrt payments, and the <br />Cali6mra Division of lndustrial Accidents. I also undeGtand I may contact t'he Callomia Contraciors' Staie Li:ense goard <br />(9SLB)st 1-80G321-CSLB (2752) or wsw.cslb.ca.oov for more information about ticensed contractors.(\tl <br />.rYVO..l an.aware,ot and consent to an Owner-Builder building p€rmit applied for in my name, and understand that I am <br />Qq plrty legalty and financially responsible ror pmposed construction activity at the folowing <br />address: <br />l lagree that, as the party legally and financially responsible for thas propos€d construction activity, I wilt abide by <br />laws and requirements thal govem Owner-Builders as well as employers. <br />agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the <br />n I have provided on this form <br />Licensed contractors are regulated by la$/s designed to protect the public. lf you contract wilh someone who do€s nol <br />have a license, tho Contractors' State License Board may be unable to assislyou with any tinancial loss you may sustain <br />as a-result of a complaint. Your only remedy against unlic€ns€d Contractors may be in civil court. ll is also important foryou to understand that it an unlic€nsed Contractor or employee of that individual or firm is injur€d whil€ working on your <br />property, you may be held liable for damages. lf you obtain a p€rmit as Owner-Builder and wish to hire Contaclors, you will <br />be responsible for verifying whether or not those Contractors are prop€dy licensed and the status of their workers' <br />compensation insurence coverage. <br />B6fo?e a building pormit can be bsuod, this form murl bc complctcd and signod by tho pro perty owner and <br />raturnod to the agency rosponalble tor l3sulng lhs pemlt. /Vote:A coov ol tho prooettv owner's ddver's license. <br />or's <br />Signature of Property <br />Print name of Owner <br />Owner Date q I oltr <br />+4.*f,,d1 Ch-tY C.s-r <br />AUTHORIZATION OF AGENT TO ACT ON PROPERW OWNER'S BEHALF <br />Excluding the Notica to Property Oflner, the execution ofwhich I undeBtaod i6 my porsonal respon8ibility. I heroby adhorize theiollowing per3on(!) to acl a8 my agont(s) to apply for, sign, and fil8lhe doclm€nta necessary toobtsin a; o*ner-iluitder permit for myprojecl. <br />Scop€ of Conslruciion Projed (or Oeecription of Work)tc l*/t))oj /t/ na,t c4 <br />Proj€ct Location or Add.ess a fi/ tnq,t (k"zt <br />Address ot Authorized Agent )<2 at 4,//4n l.4 9't ?L' <br />Phone Numbor of Authorized Agsnl <br />I decl8re under penalty of perjury that <br />informslion and cerlify its acc!.acy <br />I am tha properly o. ner for the address listed above and I parsonally llllad out the above <br />Property Oflne/s Signature t-Dale <br />Print N6me of Owne.:€.\-r- ( <br />Nole: A copy ol th. ovnafs dttvcr's liconso, fo,m no&,rization, or otha. varifrcation Dccqbblo to the ,gancy is rcqui.ed tobo pt€€€nLd when lhe po,1,,ll is itsusd ao vorify the p,!,petty ownar,s slg,r',.tuto. <br />SAITA ANA CITY COI,NCIL <br />xlaraa &c. <br />Fr&bE 6 \rs-rtrr.ffm Effi...fffr r E-inm ffi't&r..r6 FrR.{r...r}n ft ll@-s <br />q fr'f'r <br />Name o, Au'thorizod Ag.n, l r,r lor/o