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licensed subcontractors and the number of structures'does ntt exceed four within any calendar years, or all of the work is <br />performed under contract with a licensed general building Contractor. <br />t-.U't. <br />'understand <br />as an Owner-Builder if lsell 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 result from any latent construction defects in the <br />workmanship or materials. <br />LM n. ,understand I may obtain more information regarding my obligatlons 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 www.cslb.ca.oov for more information about licensed contractors. <br />L.M ',0. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am <br />the party <br />address: <br />nd finan ial res nsfble propos construct "ry)w at foll <br />r' <br />L\tt-,,,'ali*applica I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by <br />ble laws and requirements that govern Owner-Builders as well as employers. <br />_12.1agree 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 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 />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 permit. A/ote;A coDv of the Drooertv owner's driver's license <br />form notarization or other ,s to be if is <br />ued to the <br />Signature of Property Date 1k <br />Print name of Owner e 's-,t\oz< i-- <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 flle the documents necessary to obtain an Owner-Builder Permit for my <br />project. <br />Scope of Construction Project (or Description of Work) <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 lllled out the above <br />information and certify its accuracy. <br />Property Owner's Siqnature Date <br />Print Name of Owner: <br />Note: A copy of the owner's driver's license, form nolarization, 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_r, . l.r.'r:a)i r iii:..i:p/.:r:lrl-_- i.' --.'.ia <br />SANTA ANA CITY COUNCIL <br />houlrdo@santa-an..oro <br />Itayot PtoIei Watd 2 <br />mimadrnez@santa-ana oro <br />Viceate Sar..ienlo <br />vsarmlenlo@sanla-ana oro rso oro@sanla-ana oro <br />P Oavid Benavldes <br />dbeiav,des@santa ana.oro N eoas@sanla'a.a oro slL.aero@sanla ara ora <br />Proiect Location or Address: