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licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is <br />performed under contract with a licensed general building Contractor. <br />_8. I understand as an Owner-Builder if 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 defects in the <br />workmanship or materials. <br />_9. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue <br />Service, the United States Small Business Administration, the California Depa(ment of 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 'l -800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. <br />_10. 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 at the following <br />address: tq?l Eas{ i{{h Slr..{ - Sui{c- B - San {a. Acra, aA qz.?os <br />_11.1 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 />_12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the <br />information 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 wath 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 if 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 verifying whether or not those Contraclors are properly licensed and the status of their workers' <br />compensation insurance coverage. <br />Signature of Property Owner Date Y/..,lrq <br />Print name of Owner {t1 ?-An{ crri o cra LL C <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 llle the documents necessary to obtain an Owner-Builder Permit for my <br />project. <br />Scope of Construction Project (or Description of Work)I-as fnc tor Releerse ODL$ <br />lqt t East l?{h .S{rec{ - Su.ltr- B- San{a Ana cA q?-1os <br />Name of Authorized Agent {o,.rctr-*{hcr <br />Address of Authorized Agent:la3'{ E\s+ la+h Sltee} - Saq{a,Aoa 4A 9Z+ol <br />1t.t {bo- lsos rol\"I qq 3So-o1E+ <br />I declare under penalty of 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 Signature lb <br />Print Name of Owner: tYli,c. h.rc. [ (It-lcs \ f Sa., enfcr,',o BsnAcra Llf-\ <br />Note: A copy of the oiniis ariier'i licefid fori notarization, or other verification acceptable to the agency is required to <br />be presented when the permit is issued to verify the properly ownet's signature, <br />i r\i l.L i,q t-..r.i,i.i -r! /1r:.f; : jit . N]j.. i. l,r i.,ri, F.- i r i.l :,. -r. <br />SANTA ANA CITY COUNCIL <br />MrgoelA Pulido Mchee Maninez V cenle Sarmrento Jose Solono P Davrd Benavides Juan V legas SarT'.alero <br />^rayor Mavor Pro Tem, Ward 2 Ward 1 Ward 3 Ward 4 Ward 5 Ward 6 <br />ate: t{ <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 for issuing the permit. /Vofe.' A copv of the propertv owner's driver's license. <br />form notarization. or other verification acceptable to the aqencv is required to be presented when the permit is <br />issued to verifu the oropertv owner's signature. <br />Project Location or Addressl <br />Phone Number of Authorized Agent: