30135684 - Permit (2) - Laserfiche WebLink

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A- aA I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owne(s) that result from any latent consiruction defects in the workmanship or materials. ?n 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 California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1 -800-321 -CSLB (27 52)or www.cslb.ca.qov for more information about licensed contractors 63-- tne pa, 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am ly and frnanci responsible for proposed construction activity at the following Nt Ar1- I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. Q-r2. I agree to notify the issuer of this form immediately of any additions, 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 anyfinancial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. lt is also important for you to 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 veriflng 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 returned to the agency responsible for issuing the permit. Note: A copy of the propertv owner's driver's license, verification to be when the ,s a, f Ufzrl< I 6-r\C^r^,6-q.A AUTHORIZATION OF AGENT TO ACT ON PROPERW OWNER'S BEHALF Excluding the Notice to Prope(y Owner, the execution of which I understand is my personal responsibility, I hereby authorize the 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 project. Scope of Construction Project (or Description of Work):( nrt,^t|Q l:Gttrhr' tt<27.fte{uke E\ 5rur-5 Project Location or Address:Itl W, Ytth, r-l{L@f Name of Authonzed Agent:da+ Zâ‚¬Doc,a/ Address of Authorized Age 2 [rnon" Number of Authorized Agent: I declare under penalty of pequry that information and certify its accuracy. 5iE.Ct- lam property owner for the address listed above and I personally filled out the above Propefty Olvner's Srgnature Print Name of Owner:F-.<\an C-l"tc,-'*- tr*A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when lhe permit rs lssued to verify the propefty owner's signaturc. Mrguel A Puhdo Mayo. MPulrdo@santa-ana.orr Vrncst F SafiEnlc Mayor Pro Tem, Ward : Vsarm6to@santa:ana org SANTA ANA CITY COUNCIL Mchele li,tanrne; AngelrG Arnma Ward 2 Ward 3 Sal Trna,erc ward 6 MManrneziosanta-ana.qo AAmezcua(asanta-ana.ore DBâ‚¬navrdesrAsanta-ana crc RRevna@santa-ana.orc STrnaarcfAsanta-ana.om P Davd Bfrauds Ward a R@n Reyna Ward 5 Signature of Property Print name of Date