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?017'07-04 09:20 s025 8303938146 >r P 2/3
<br />licensed subc-onlraotors and the number ol struclutes does not excoed lour w(hin ally calandar years, or all of the work i3perlorm6d under contrSct tr/ilh a licensed general building Contraclor.
<br />56 , , undersland as an OwnerBuilder if ls€llthe prop6(y lorwhich lhis permil rs rssued, I may be held liable tor anyfrnanciar or porsonar iniurros susreined by any subsequbnr'owrierlsl tnar resui rrom any latem coniiruaron derects in rheworkmanship or malgnal6.
<br />SA, t ulglrsl?ld I may obtain more rnrormafion regard'ng my obr,garrons as an .emproyer', rrom rne rntgr43l 6sys6r,sS6rvice, the Uniled States Smatt Busine6s AOmrn,strati;, thetat,tornii bepartmenr ot Blnltit eayrenis, ino tneCalilornia Divlsion ol hdustrial Accidenls. I also under6End t may conai tne california Conlracors, Slale Licenss Board(CStB) al 1.800'321.CSLB (?752) or !,ww.c6tb.ca.oov lo, more rnformation about lrensed contractors.
<br />${t0. lam ar"are o, and consent to an Owno,-Builder buildi ng permil applied ior in my name, and und8rstand thal tamthe pany legally and financral ty nsL lor proposedsF construclonStu+r ivily ar the,ollowi r)0c{address c/ft
<br />*4^_l:.llr,::_tl.-t::]ll9l31I]-e.lry "nd
<br />{inEncr8llyresFronsibre tor rhis proposed consrrudion acriviry, twiil abido bya[ apprcaDre rayys and requrremenls lhat gov6m Owner_guilders a6 lvell as employers.
<br />Slit2. I agree to noldy the rssuer ol thi6 form immodiately ol any additions, detolions, or changes lo any ot th6inl67n31lon Ihave provijed on this lorm.
<br />Licensed contraclors are r€oulaled by laws desbned ro protect th€ public. ll you contrad with someone who ooes nothave a llcense, fi6 conl.adors' stato License Board miy be unaoii ro assisfyou witr iny linanciairofi pu'may susrain
<br />T.:.1".{ .-T::Tl]arnt. Your onty remedy againsr unticensed Conrractofs riay be in civit coun. rt is irlo imp6rranr to,you to undersland that il an Unlicsnsed Conlraclor or employBe ol lhar individuator lirm rs rnjured Mlrte working on you.prop€ny, you may be hetd liable lor damages. l, you obtain a permit as Owner_Buitder and ;ish to hrra Contac'lors,'you witt
<br />bB rBsPonsible.lor ve.ifying whether or not those ConlractorE dre proparty ticensed and tho status of tfren wJ*ers,
<br />compensation insurance covera916.
<br />Belore I bulldlng petmll can be lssusd, thls lorm must be completod and 3ignod by the proporty ownar.nd
<br />retumed to the sgency responslble lor issulno the pormll. lrote;,on
<br />Signarure ol Properly Owner Date:7s'r7
<br />Prinl name o, Owner s ql
<br />AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
<br />9l:'rO,ng tn" Notce lo PrOpeny Orner. the ereculion Ol w']ich I underslaM ts my personat responsibllity, I her€Dy authonze thelollos/ing P€rson(s) to 8d as my agen(s) lo apply lor, slgo, and lile the documenli necessary to oblain a; Ow)er-6uilder peim,ilor myprol€ct.
<br />Scrrpo ol Construction Pro/ect (or Oescnprron ot Worfy, Vt^e--\)ttu{-fryrtvce
<br />P/o,ed Locator) or Addre6
<br />Naore ol Authorized Agenl
<br />,, 2gg3---S.-
<br />dr{rabe-(
<br />Address ol Authonzed Ageol:r2r3 W.C-ubbop s't.Qz?u 7
<br />Phon6 Number oJ Author.zed Agent; .]g:-33 z-Z3sl
<br />I ooclare under penalty ol perjery thai I am owner ,or tho addfess lsted abovs and I personally tilled out tne abovernformatioo and certily its
<br />Propcdy Orrneas Signalu re.Dale 5-f7
<br />Prinl Name ol Owner \Va-t-)
<br />Nolrt A cgpy o, the ownat s d aor's ticen
<br />be Preaamed when th. parml, b brued ,o
<br />/i trr 11. r', 1.ilaifuA(rr'l, A-:i n:r,,ri.r ! ;.-,"a c rur,\ t.,l
<br />5e,m aota,lizalloo, ot olhc. vctfitcatlon rcr,?'ptabte lo lhe ogency I5 roqutrcd bust y lhe propeiy ow,lo. s
<br />'lgnglute.{ i4 itrl
<br />SANTA ANA CII V COUNCII.
<br />!&!4@8ff:acrs!
<br />i,kvd Pri 16, w&6 2
<br />.5:ll@rll!!!El!.i€Lg!EIET'QEIIAAI $-I ]llritllAtrdltl.llr! &E4lu]j}rrllriasr!
<br />i!ownet
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