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licensed subcontractors and the number ol structures does not exceed four within any calendar years, or all of the work is <br />performed under contracl with a licensed general builAing Contraclor. <br />,2-y, 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 owne(s) that result from any latent construction defects in the <br />workmanship or materials. <br />!l g I understand I may obtain more inlormation regarding my obligations as an "employef'Irom the lnternal Revenue <br />Service, the United States Small Business Administration, the California Department of Benefit Payments, and the <br />Cafifornia Division ol lndustrial Accidents. I also understand I may contact the California Contractors' State Llcense Board <br />(CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov Ior more information about licensed contractors. <br />TIJ (V tO.l am aware of and consent to an Owner-Builder building permit applied Ior in my name, and understand that I am <br />the party <br />address: <br />legaliy and finan ly res onsible fo propo sed cons uction activ Ity at the f ollo wrng <br />)__Ltt.l agree that. as the party legally and f inancially 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 />]_&f Z. I agree to notify the issuer of this lorm immediately of any additions, deletions, or changes to any of the <br />information I have provided on this f orm. <br />Licensed contractors are regulaled 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 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 OwnerBuilder 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 />Belore a building permit can be issued, this torm must be completed and signed by the property owner and <br />returned to the agency responsible for issuing the permit. A/ote.' A coDv ot the DroDertv owner's driver's license. <br />form notarization, or other cation acceDtable to the aoencv is reouired to be ted when the permit is <br />Signature of Property Owner Date f/0,/rq <br />Print name ot Owner r |E= cl-S D, nz- t'/ o g@r' eJ rq <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 authorize the <br />following person(s) to act as my agent(s) to apply 1or, sign, and file the documents necessary to obtain an Owner-Builder Permit for my <br />project. <br />Scope of Construction Project (or Description of Work) <br />Project Location or Address <br />Name of Authorized Agent <br />Address of Authorized Agenl: <br />Phone Number ol Authorized Agent <br />ldeclare 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 Owneis Signature Date <br />Note: A copy ot the owner's driver's license, form notarization, or other verification acceptable to the agency is required to <br />be presented when the permit is issued to verify the properly owner's signature. <br />SANTA ANA C TY COUNC]L <br />mo! l do@sanla'ana oro <br />rMayo. Pro lem, Ward 2 <br />mma4rne?@saoG:a!a.a& <br />V cenre Sarmie.lo <br />vsamrenlo@sanra-ana.oro 6olono@sanra ana oro <br />P. Dav d Benavides <br />dbenavrdes@santa ana.orc Nilleoas@santa a.a oro slrnaiero(asanla ana.oro <br />issued to verifv the proDertv owner's sionature. <br />Prinl Name of Owner: