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licensed subcontractors and the number of structures does not ex:eed toir within any calendar years, or all ol the work is <br />performed under contract with a licensed general building Contractor. <br />-rff 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable lor any <br />Iin-ancial or personal injuries sustained by any subsequent owne(s) that result from any latent construclion defects in the <br />workmanship or materials. <br />t( g. t understand I may obtain more information regarding my obligations as an "employea'f rom the lnternal Revenue <br />Service, the United States Small Business Administration, the California Department ol Benefit Payments, and the <br />California Division ol 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 />,/)1ff lO.I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am <br />the party legally and financially responsible for proposed construction activity al the following <br />+t{ f t. I agree that, as the pady legally and financially responsible for this proposed conslruction activity, I will abide by <br />all applicable laws and requirements that govern Owner-Builders as well as employers. <br />'tK p.I agree to notity the issuer of this form immediately of any additions, deletions, or changes to any ol the <br />information I have provided on this f orm. <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 clvil 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. ll 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 permit can be issued, this form must be completed and signed by the property owner and <br />returned to the agency responsible lor issuing the permit. /Vote.' A coDv ol the propertv owner's driver's license. <br />r ther verification the ,s ul when the <br />,s o si natu <br />address: <br />Signature of Property Owner <br />Pnn: name ol Uwner -r-1u t€tJ -'t*NJ -tl ?+lMt4 <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 pArson(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit lor my <br />project. <br />Scope of Construction Project (or Description of Work) <br />Prolect Location or Address <br />Address ol Authorized Agent: <br />Phone Number of Authorlzed Agent <br />I declare under penalty of perjury that I am the property owner for the address lisled above and I personally filled out the above <br />information and certify its accuracy. <br />Property Owner's Signature Date <br />Print Name ol Owner <br />Note: A copy ol the owner's driver's license, form notarization, or other verilication acceptable to the agency is required to <br />be presented when the permit is issued to verify lhe property owner's signature. <br />SANTA ANA CI'IY COUNCIL <br />mpuldo@sanra ana.oro <br />Mayor Pro Tem. Ward 2 <br />mrmaninez@sanra ana.oro <br />vrcenle Sarmrenro <br />vsarm erlo@sanra ana.oro <br />P. Davld Benavrdes <br />dbe.avdas@sarla.ana.oro $!eis!@seda:a!a4lgisolono@sanra ana oro iv eoaslasanta ana oro <br />Name of Authorized Agent: <br />-