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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 ContractE". <br />-6, U. , understand as an Owner-Builder if I sell the property for which this permit as 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 />(r" g 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 lnduskial 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.qov for more information about licensed contractors. <br />€V rc.1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am <br />the party legall <br />address: 2a <br />y and financially responsible for proposed construction activity at the following <br />3 7 5 /n<;fJ c ,+.t= gt-J1 /r ./r'./ /? C44 .'t -LaQ , <br />l'W ll .l 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 />(t, p.l 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 />form notarization, or other verification acceptable to the agency is rcquired to be presented when the permit is <br />issued to the owner nature. <br />Signature of Property Owner <br />Print name of Owner caZt ?€ r,C.z' <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 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 ALrhorized 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 presenled when the permit is issued to verify the property owner's signature. <br />P..l],,:]:i.r-i.'l-lr\i:',-.r.:|i.'..']i)r:r',.:....),]...\,|. <br />SANTA ANA CITY COUNCIL <br />moul do@santa-ana oro <br />Mayor Pro Tem. Ward 2 <br />mrmart'nezaAsanta-ana ora <br />Vicenle Samienro <br />vsam enlo@santa-ana oro i!9Er!9@$!E:4a <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 />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 />Phone Number of Authorized Agent: <br />P Davrd Benavides Juan Vllegas Sallinajero <br />Ward 4 Ward 5 Ward 6 <br />dbenavrdes@sBnta€naoro ivilleoas@santa-ana.oro sti.alero@sanla€nao.o