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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 />pe ed under contract with a licensed general building Contractor. <br />. I understand as an Owner-Builder if I sell the property for wh <br />I or personal iniuries sustained by any subsequent owne(s) th <br />8 ich this permit is issued, I may be held liable for any <br />tna cra at result from any latent construction defects in the <br />wor manship or materials <br />9. lunderstand lma y obtain more information regarding my obligations as an "employer" from the lnternal Revenue <br />C <br />ervice, the United States Small Business Administration, the California Department of Benefit Payments, and the <br />alifornia Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board <br />) at 1-800-321-CSLB (27 52) or www.cslb.ca.qov for more information about licensed contractors <br />0. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am <br />L e party legally and financially responsible for proposed constructimoh+ a,rrwla tnz\ <br />on activitv at the followinoqzlo<ad ress: AGe ?- <br />p pli <br />1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by <br />cable laws and requirements that govern Owner-Bullders as well as employers. <br />2. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the <br />ormation 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 as 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 Contractors are properly licensed and the status of their workers' <br />compensalion 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 for issuing the permit. ,Vote.. <br />form notarizatio n or other verification acceDtable to the aqencv is reouired to be nresen ted when the Dermit is <br />,ss the o <br />Signature of Property <br />Print name of Owner <br />Date 4-t>tq <br />e-G t'l rve.ros <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 of Construction Project (or Description of Work)tca 1.9 <br />^[r <br />( <br />Project Location or Address 00'{a66'n|&.a ltnos <br />Name of Authorized Agent: <br />Address of Authorized Age <br />rcn ,ll <br />n,7(tSL Atul o /l+Srrritr A qZTE <br />Phone Number of Authorized Agent <br />-1t+1Ll3-t271 <br />I declare under penalty of perjury lamthep ner for the address listed above and I personally filled out the above <br />information and certify its accurac <br />l^[-x)-tL1qProperty Owner's Signature Date <br />Print Name of Owner:v{-r <br />Nole: A copy of the owner's s license, form notarizalion, or other verification acceptable to the agency is required to <br />be presented when the permit is issued to verify the propefly owner's signature <br />SANTA ANA CITY COUNCIL <br />mou do@santa-a.a oro <br />Mayo. P.oTem Ward 2 <br />mimarl nez@sanra ana.o.o <br />Vrcenie Sarmienlo <br />vsarm ento@sanla-ana.oro so or o@sarla-ana oro <br />P Dav'd Aen.vdes <br />dbe.avdes@santa-ana oro rvilleoas@santa'ana!!q slimie.o@santa-a.a oro <br />A copv of the DroDertv owner's driver's license.