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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. I <br />-n l. a t understand as an Owner-Builder af 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 subsequent owne(s) that resuli from any latenI construction defects in the <br />workmanship or materials. <br />>vt 9. I 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 (27s2)or www.cslb.ca.oov for more information about licensed contractors <br />5H IO. I am aware of and consent to an Owner-Builder building perm it applied for in my name, and understand that I am <br />the party legally and financially responsible for proposed construction activity at the following <br />address: <br />)1 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 />*\ e. 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 individual or firm is iniured 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 />compensation 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 perm it. Nofe.' A coDv of the oroDedv own er's driver's license, <br />form notarization.or other verification acceptable to the aoencv is reouired to be ted when the permit is <br />issued to verifv the owner's siqnature..t ,rorof 4 lvtwb'' <br />oat", l?-15'b/tyu.l (( <br />Signature of Property Owner <br />Print name of owner ?kvvN l1n Ptr:Nt,tp <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)F\ <br />Proj ect Location or Address: lO54 Vrl. Sz r^l-6twal . <br />Name of Authorized Agent: <br />Address of Authorized Age <br />t(a ( <br />nt: I 6L C<-r,^*'/IL UI lz 2.1 Do LA. 1A cao$? <br />Phone Number of Authorized Agent 3Lj-? b6- S L,.tt'?- <br />I declare under penalty of perjury that I am the prop erty owner for t D address listed abpve a <br />It-r+. (+ ^''-ft't Yet^l-nd I personally lllled out the above <br />information and certify its accuracy h't7-r9Property 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 propedy owner's signature. <br />SANTA ANA CITY COUNCIL <br />moulido@santa ana.o.o <br />Mayor Pro Tem, Ward 2 <br />mimarlinez@santa ana.oro <br />VrcenteSamiento <br />vsam ento@santa-ana.oro solorloOsanla-ana.oro <br />P Oavd Benavrdes <br />dbenavrdes@santa-ana oro vll eoas@santa-ana.oro sl naiero@sanla-ana.oro