HomeMy WebLinkAbout20139350 - Permit/!uo,o*
) Y MiguelA PulidoI MAYoR PRO TEM
Lisa Bist
COUNCILMEMEERS
Claudla C. Alvarez
Cador Bustamante
Albena D- Christy
Mike Carcia
,ose Solorio
C]IY MANAGER
David N. Ream
CITY ATTORNEY
Joseph W. Flet(her
CLERK Of THE COUNCIL
Patricia E. Healy
CIry OF SANTA ANA
PI-ANNING & BUILDING AGENCY
20 Civic Center Plaza . P.O. Box 1988
Santa Ana, California 92702
www.5anta-ana.org
owNER-BUTLDER VERIFICATION (HSG 19831)
Attention Property Owner:
An "owner-builde/ building permit has been applied for in your name and bearing your signalure.
Please complete and return this information at your earliest opportunity to avoid unnecessary delay in
processing and issuing your building permit. No building permit will be issued until this verificalion is received.
(Read information on Page 2 prior lo completion of this form.)
'1. I personally plan to provide the major labor and materials for construction of the proposed property
improvement, (f6O or no)
I (have/have not)
proposed work.
signed an application for a building permil for lhe
t 2o61jso
2
3. I have contracted with the following person (firm) to provide the proposed construclion:
Name
Address City
Phone Contractor's License No.
4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise
and provide lhe major work:
Name
Address
Phone
City
Contractor's License No
5. I will provide some of the work, but I have contracted (hired) the following persons to provide the work
indicated:
NAME ADDRESS TYPE OF WORK
Signed:i%zeazz-o.:Oruzt-<5Property Owner (print):
Property Addres
Date: €:
I t-a-
PHONE
qaI)
Form of ldentification
Address:
Ofiice Use Only:
Permit No: