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licensed subcontractors and the number of structures doe's not "r"""a four within any calendar years, or all of the work is <br />performed under contract with a licensed general building Contractor. <br />5-li A. t understand as an OwnerBuilder rf 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 owner(s) that result from any latent construction defecls in the <br />workmanship or materials. <br />$ 4 t. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Bevenue <br />Service, the United States Small Business Administration, the California Department of Benefit Payments, and the <br />California Division ol lndustrial Accidents. I also understand I may contact the Calilornia Contractors' State License Board <br />(CSLB) at 1-800-321-CSLB (2752) or for more inlormation about licensed contractors. <br />/,1a!!!lO I am aware of and consen't to an Owner-Builder building permit applied for in my name, and understand that I am <br />the party legally and flnancially r6spopsible for groposedponstrucJion activ <br />addiess: - l.\Oq < flci I/ tr.o S,:,,r,\s 4a"., (*' ct)!.{h" totto*ins <br />e4 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 />JIAI2. I agree to notify the issuer of this lorm immediately ol any additions, deletions, or changes to any of the <br />inlormation 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 il 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 verilying whether or not those Contractors are properly licensed and the status of their workers' <br />compensation insurance coverage. <br />Before a building permil can be issued, this lorm must be completed and signed by the property owner and <br />returned to the agency responsible lor issuing the permit. Note; A copv of the DroDertv owner's driver's license. <br />form notarization, or othet veritication acceptable to the agency is required to be presented when the permit is <br />issued the wner s nature, <br />5.30',Joi'lSignature of Property <br />Print name of Owner 5 <br />Owner Date: <br />e <br />AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF <br />Excluding the Notice to Property Owner, the execution ol which I understand is my personal responsibility, I hereby aulhorize the <br />following person(s) lo act as my agent(s) to apply 1or. sign, and iile the documents necessary to obtain an Owner'Builder Permit for my <br />project. <br />Scope of Construction Project (or Description ol Work) <br />Project Location or Address <br />Name of Authorized Agent <br />Address of Authorized Agent <br />Phone Number of Authorized Agent <br />ldeclare under penalty of perjury lhat 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 />Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to <br />le presen.ted ,wh:n the leyit is i?sued to verify the property owner's signature. <br />SANTA ANA CIIY COUNCIL <br />mpuldo@santa-ana.oro <br />[rayor Pro Tem, Ward 2 <br />mlmanrne2@sanra ana.oro vsamento@santa ana.oro ana oro <br />P Davd Benavdes <br />dbenavrdes@sanla.ana.oro ivilleoas@sanra.a.a on slBier9@t344:a!a.qq <br />?"'Y <br />Print Name of Owner: