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MAYOR <br />MiBUel A. Pulido <br />MAYOR PRO TEM <br />Brell E. Franklin <br />COIJNCIT MEMBERS <br />Claudia C. Alvarez <br />Lisa Bist <br />Alberla D. Chrisry <br />Mike Carcia <br />Jose Solorio <br />CITY MANACER <br />David N. Ream <br />CITY AITORNEY <br />,oseph W. Fletcher <br />CLERK OF THE COUNCIL <br />lanice C. Cuy <br />CITY OF SANTA ANA <br />PTANNING & BUII,DING AGENCY <br />20 Civic Cenler Plaza (M-19) <br />P.O. BOX 1988 ' Sanla Ana, California 92702 <br />t ax 1714) 647-5878 <br />www.sanla-ana.org <br />owNER-BUTLDER VERTFTCATTON (HSC 19831) <br />Attention Property Owner: <br />An "owner-builded building permit has been applied for in your name and bearing your signature. <br />Please complete and return this information at your earliest opportunity to avoid unnecessary delay in <br />processing and issuing your building permit. No building permit will be issued until this verification is received <br />(Read information on Page 2 prior to completion of this form.) <br />y1. I personally plan to provide the major labor and materials for construction of the proposed property <br />improvement (yes or no) <br />t 2. I (have/have not) <br />proposed work. <br />signed an application for a building permit for the <br />3. r I have contracted with the following person (flrm) to provide the proposed construction <br />Name Q Sc-?E- <br />Address <br />Phone ?.6 <br />City <br />\Contractor's License NorA- <br />4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise <br />and provide the major work: <br />Name <br />Address <br />Phone <br />City <br />5 I will provide some of the work, but I have contracted (hired) the following persons to provide the work <br />indicated: <br />NAME ADDRESS PHONE TYPE OF WORK <br />Signed <br />Property 5'4t t .tq a looffzdutz-wner (print) <br />Date: \*za. o { <br />Contractor's License No. <br />yLtu,/o fr*./;**' <br />PropertyAddress: rZ3 <- .2.a"-- 7-7-.y'.