10193434 - Permit (3) - Laserfiche WebLink

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Iicensed subcontractors and lhe number of slructures does not exceed four within any calendar years, or all of the work is pe d rmed under contract with a licensed general building Contractor rnancra I understand as an Owner-Builder il I sell the property for which this permit is issued, I may be held liable for any or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workr5ranship or malerials. /lfllr. ,understand I may obtain more information regarding my obligations as an "employea'from the lnternal Revenue 'Seri,ice, the United States Small Business Administration, the Calilornia Department of Benefit Payments, and the Calilornia Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (6SLBI at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contraclors. m\r l am aware of and consent to an Owner-Builder building permlt applied lor in my name, and understand that I am tne party legally and financially responsible for proposed construction activiiy at the following addresq:IN,/t-tlappltp 4L',rl informati . I agree that, as the party legally and Iinancially responsible lor this proposed construction activity, Iwill abide by able laws and requirements that govern Owner-Builders as well as employers. I agree to notify the issuer ol this lorm immediately of any additions, deletions, or changes to any of the on lhave provided on this form. Licensed contractors are regulated by laws designed to protect the public. ll 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 civil court. lt is also important for you to understand lhat 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. ll you obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible for verifying whether or nol 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. l/ole.'t owner's driver's I icense lorm notarization. or other ve rification acceotable to the adencv is reouired to be sented when the Dermit is the e owner s s natu Signature ol Property Owner Date V--s-zt- Print name of Owner AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Properly Owner. the execution ol which I undersland is my personal responsibility, I hereby authorize the tollowing person(s) to act as my agent(s) to apply lor. sign. and li e the documenis necessary to oblain an OwnerBullder Permit for my prolect. Scope of Construction Project (or Description ol Work) Project Location or Address Narne ol Authorized Agent Address ol Aulhorized Agent Phone Number ol Authorized Agent I declare under penalty of perjury that I am the property owner for the address listed above and I personally lilled out lhe above information and certify its accuracy. Property Owners Signature Date Print Name of Owner Note: A copy ot the owner's driver's license, form notarization, or other veritication acceptable to the agency is required lo be presenled when the permit ls issued to verify the propetty owner's signature. SANTA ANA CITY COUNCIL muldo@sanla-ana o.o Mayoi Pio Tem. Wa.d 2 a-aa!ag@!a4a qc &loiio@sa.la..na oro P Orvd Banauder dbenavdes@sanla.a.a oro ivr!e!tr@rt!E: ruIc