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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 performed under contract with a licensed general building Contractor' /,, 8. I understand as an OwnerBuilder if I sell the property for which this permit is issued, I may be held liable for any finanbial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. .,., f " g. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Service, the United States Small Business Administration, the Californra Department of Benefit Payments, and the California Division of lndustrial Accidents. I also understand I may contact the Calilornia Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. / 7)1 O. I am aware o{ and consent to an Owner-Builder building permit applied for in my name, and understand that I am the part ally and {inancially responsible for propose dco nstruction actlvity at the following addr tl z 5 lb5i/t7E Eta6 *J t! l l ll.l agree that, as the party legally and financially responsible for this proposed conslruction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. /t:-L12.1 agree to notify the issuer of this f orm immediately ol any addilions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. lf you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in clvil court. lt is also important for you io understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. lf you obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by the property owner and relurned lo the agency responsible Ior issuing t t. /Vo A coDv of Drolrerlv owner's driver's liccnse. n her verification a ,s ired when the issued to ownef's n Date 5 .20ztSignature of Property Owne Print name ol Owner TAca! SHo/Llbt ft.r, AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Properly Owner, the execution of which I understand is my personal responsibilily, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and lile the documents necessary to obtain an Owner Builder Permit ior my project. Scope of Construction Project (or Description oJ Work) Prolect Location or Address Name ot Authorized Agent Address of Authorized Agent:- Phone Number of Authorized Agent I declare under penally ol perjury that I am the property owner for the address listed above and I personally Iilled out the above information and certify its accuracy. Property Owner's Signature Date Print Name of Owner Note: A copy of the owner's drivet's license,lorm notarization, or other ve tication acceptable to the agency is required to be presented when the permit is issued to verily the propetty owner's signature. SANTA ANA CITY COUNCIL mo!lido@santa.ana.oro N,layor Pro Tem. Ward 2 m man nez@sanla ana oro vsarm enlo@sanla.an a oro i&lqie@s!!la:3!3.p!c P Davd B-anavdes dhelavide!@sad!:elaqc ivilgla!@!3!l&a!eer!srrraiero@santa'ana.oro