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licensed subcontractors and the number of structures does not exceed four within any calendar years, or all ol the work is <br />pedo./]r.ed under contract with a licensed general building Contractor. <br />V 8. I understand as an OwnerBuilder il I sell the properly for which this permit is issued, I may be held liable for any <br />finarrc,ral or personal injuries sustained by any subsequent owne(s) that result from any latenl construction delects in the <br />workmanship or materials. <br />\ / 9. I understand I may obtain more information regarding my obligations as an "employer" lrom the lnternal Bevenue <br />Se-rvice, lhe United Stales Small Business Administration, the California Department of Benefit Payments, and the <br />Calilornia Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board <br />at 1-800-321-CSLB (2752) or www.cslb.ca.oov lor more information about licensed contractors <br />0. I am aware of and consent to an er ul building pe app Ior <br />the party legally and f inanciall y responsible rp cllo n tth llowin <br />,"Y' <br />V1 <br />address <br />,/ ,, <br />my na and understand that lam <br />S <br />I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by <br />all a,)plicable laws and requirements that govern Owner-Builders as well as employers. <br />V lZ. t agree to nolify lhe issuer of this form immediately ol any additions, deletions, or changes to any ol the <br />information I have provided on this form. <br />Licensed contraclors are regulated by laws designed to protecl the public. lf you contract with someone who does not <br />have a license, the Contractors' Stale License Board may be unable to assist you with any financial loss you may sustain <br />as a result ol a complaint. Your only remedy against unlicensed Contraclors may be in civil court. lt is also imporlant for <br />you lo understand that if an unlicensed Contractor or employee ol 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 ol their workers' <br />compensation insurance coverage. <br />Before a building permit can be i .lhis form ed and signed by the property owner and <br />returned lo the agency resp onsib iss u in t owner's driver's licen <br />lorm notatization or uired to be n <br />to the <br />Signature ol Property O Date <br />Print name of Owner <br />AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF <br />Excluding the Nolice to Property Owner. the execution of which I understand is my personal responsibility, I hereby aulhorize the <br />following person(s) to acl as my agent(s) to apply 1or, sign, and lile lhe documenls necessary lo oblain an Owner-Builder Permit for my <br />project. <br />Scope of Construction Proiect (or Descriplion ol Work) <br />Project Location or Address <br />,r/r r+k <br />Name ol Authorized Agent: <br />Address of Authorized Agent <br />Phone Number ol Authorized Agent <br />I declare under penally of perjury lhat I am the properly owner lor lhe address listed above and I personally filled out the above <br />information and certify its accuracy. <br />Property Owneas Signature Date <br />Print Name ol Owner <br />Note: A copy ol the owner's driver's license,lorm notarizalion, or other verification acceptable lo the agency is required to <br />be presenled when the permit is issued lo verity the propefty ownet's signature. <br />SANTA ANA CITY COUNCIL <br />mouldo@santa.ana oio <br />Mayor Pro Tem. Ward 2 <br />mrroahez@sanra.a.a oro vsam cnlo(asaf la.na.oro Eda@@lada:aE q! <br />P Dav'd B6.avdes <br />db€nevdes@sa.ra ana oro igXel4@rada:ala.ll!sr,raiero@sa.la ana oro