10193651 - Permit (3) - Laserfiche WebLink

Home Browse Search

,/ 9. 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 Califomia Department of Benellt Payments, and the Califomia Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at '1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. J 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: J 't't.l agree that, as the party legallyand financially responsible for this proposed construction activity, lwill abide by all applicable laws and requirements that govem Owner-Builders as well as employers. ---f12.I agree fo 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. lfyou contract with someone who does not havea license, the Contractors' Slate License Board may be unable to assist you with any financial loss you may sustain as a result of a com plaint. 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 verirying whether or not those Contractors are properly licensed and the status of lheir 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. /Vote; A coDv of the Drooeftv owner's driver's license, lorm notaization, or other rificali acce able to the a nc rs be sen e sionature. Signature of Property Owner Date Ct1 lrll t7 DANJ&f*r,.i AUTHORIZATION OF AGENT TO A ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property 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 ot Work) Project Location or Address Name of Authorized Agent Address of Authorized Agent Phone Number oI Authorized Agent I declare under penalty of perjury that I am the property owner for the address listed above and I personally tilled out the above information and cediry its accuracy. Print Name of Owner: Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the propedy owner's signature. -..,'.-t'.,..: SANTA ANA CITY COUNC]L mouIdo6senlr-an. oro Vice.re s3mrenlo 6am e.to@sa.t! ana oro GolMo@sa.lr-ana oro P Oavrd 8â‚¬na,6es dbenBMdes@se.la-ana.o.o lylLeg!5@!e!E:!!i,9!9 snnaeroosanla a.a oro Print name of Owner Property Owner's Signature: Date:_ Mchoâ‚¬ Ma,nna Mayor Pro Tem, Ward 2 mrmedrne2@sanla-a.a oro