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I understand ". "n O*n"r- r if I sell the property for which this perrfissued, I may be held liable for any <br />or personal injuries sustained by any subsequent owne(s) that result from any latent construction defecls in tiie <br />anship or materials <br />. I understand I may obtain more informalion regarding my obligations as an "employea'from the lnternal Revenue <br />, the United States Small Business Administration, the California Department of Benefit Payments, and the <br />ia Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board <br />at 1-800-321-CSLB (2752) or rvww.cslb.ca.oov 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 />th rty legally and financially responsible for proposed construction a ity at the lowi <br />SS <br />1'1 . I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by <br />icable laws and requirements that govern Owner-Builders as well as employers <br />. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the <br />rmation 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 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 Contractors are properly licensed and the status of their workers' <br />compensation insurance coverage. <br />Before a building permit can ed,ts rm <br />th <br />ust be completed and signed by the property owner and <br />returned to the agency res for u permit. /Vofe.' A copv of the propertv owner's driver's license, <br />,s <br />Signature of Property Owner Date: <br />Print name of Owner eour}e(0 <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) <br />Project Location or Address _-=' <br />Name of Authorized Agent;n <br />Address of Authorized Agent:{ <br />Phone Number of Authorized Ag <br />I declare under penalty of pe r for the address listed above and I personally lllled <br />information and certify its <br />Property Owner's Signature:Date: <br />e <br />Note: A copy of the owner's drivels license, form notadzation, or other veificatlon acceptable lo lhe agency to <br />be presented when the permit is issued to yerify the prope,Ty owner's signaturc <br />PLink:WP51/CounterActivity/AssemblyBillslNotice to Propeny Form 03-14'2016 <br />SANTA ANA CITY COUNCIL <br />sibl <br />?E: <br />MfiIW <br />lam <br />MPulidolasanla-ana o.o <br />Mayor Prc Tem, W6rd 1 <br />VSamienb@sanle-ana.oro MManin6z@sanl.-ena.oro AAmezcu@santa-ana.oro <br />P David Ben.vid6 <br />DBenavdes@sanb a.a oro RReha@s.nla-ana oro STin6i6ro@s6nr6-rne oro <br />l <br />Print Name of Owner: