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1 <br />licensed subcontractors and the number ol structures does not exceed lour within any calendar years, or all of the work is <br />performed under contract with a licensed general building Contractor.'Tr <br />I L8. I understand as an Owner-Builder il I sell the property for which this permit is issued, I may be held liable for any <br />frn-ancral or personal injuries sustained by any subsequent owne(s) that result from any latent construction delects in the <br />workmanship or materials. <br />I understand I may obtain more information regarding my obligations as an "employea'from the lnternal Revenue <br />Service, the United States Small Business Administration, the California Department ol 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 />IBo <br />the party <br />address: <br />lam <br />leoall-lL <br />aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am <br />v and linancia nsible I or orooosed conS";L ,("-struction activl ty at the following <br />< c v.\1 C*q r7o3 <br />TEt.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 />-fu12. lagree to notify the issuer o{ this form immediately of any addilions, 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 Ioss you may sustain <br />as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. lt is also impodant for <br />you to understand that if an unlicensed Contractor or employee of that lndividual or firm is injured while working on your <br />property, you may be held liable for damages. ll 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 lorm must be completed and signed by the property owner and <br />returnedtotheagencyresponsibleforissuingthepermit.Note: <br />form notarization, or other verification acceDtable to the aoencv is reouired to be ted when the Dermit is <br />owner's si nature. <br />Signature ol Property Owner Date S l0 <br />Print name of Owner ", EL""4 <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 file the documents necessary to obtain an Owner-Builder Permit for my <br />project. <br />Scope ol Conslruction Project (or Description of Work) <br />Project Location or Address <br />Name of Authorized Aoent <br />Address of Authorized Agenl <br />Phone Number oi Authorized Agent <br />I declare under penalty ot 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 S gnature Date <br />Print Name of Owner <br />Note: A copy ot the owner's driver's license,lorm notarization, or other veriflcation acceptable to the agency is required lo <br />be presented when the permit is issued to verily the property owner's signature. <br />) r v,i ii,.r... i,.,. . t i.i.r!. irirri. :.r:.r_ rl lii!.-t! t r :. a:' 1.1 llli <br />SANTA ANA CITY COUNCIL <br />mouirdo@santa-ana oro <br />Mayor Pro Tem, Wad 2 <br />4m!nl!ez@!a!la:a!@ <br />Vrcente Sarmlenro <br />vsa,m ento@sanra'ana oro isolorio@sanla-a.a.oro dbenav dcs@sanla 3.a oro tilleoas@santa.ana.oro sl naiero@sanla-ana.o.o <br />ly <br />I