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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 />0P 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 />D-€ g. 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 Department 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 1-800-321-CSLB (2752)or www.cslb.ca.qov for more information about licensed contractors <br />!Y rc.I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am <br />tne party legally and financially responsible for proposed construc.-tion activiiy at the following <br />address: <br />D/ ll.l 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 />Of e. t agree to notify the issuer of this form im mediately 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 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 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.' A copv of the propeftv owner's driver's license, <br />form notarization .or other verification acceDta ble to the adencv is reouired to be Dresented when the Dermit is <br />ssued to veri the owner's nature. <br />Date: q /" /lqSignature of Property Owner <br />Print name of Owner D?n,r. 2o "/o. <br />AUTHORIZATION OF AGENT TO ACT ON PROPERry 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: <br />Address of Authorized Agent: <br />Phone Number of Authorized Agent: <br />I declare under penalty of perjury that I am the property owner for the address listed above and I personally fllled out the above <br />information and certify its accuracy. <br />Property Owner's Signature Date <br />Print Name of Owner: <br />Note: A copy of 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 yerify the propedy owner's signature. <br />r,: |f ii\ii:,arr:,r rri._ ri.,,ri t:,:rri|]liij rt;.r:.i:ti.p.1;.it:t r:,..:.t) trti. <br />SANTA ANA CITY COUNCIL <br />nou do@santa ana o.o <br />Mayo. Pro Tem, Ward 2 <br />mimarline2@sa.la-ana.o.o <br />V cenle Samre.lo <br />vsarm €.to@sanla-ana oro <br />,/, <br />so !r o@sa.1a-ana oro <br />P Davd Benavdes Jua.V eg.s SalTina,ero <br />Wa.d 4 Wad 5 Ward 6 <br />dbenavrdes@sanla-ana.ora ivilleoas@sanla-a.a oro slrnalero@sanla'a.a oro