10293433 - Permit (3) - Laserfiche WebLink

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licensed subcontractors and the number ol structures does not exceed lour within any calendar years, or all of the work is perFormed under contract with a licensed general building Contractor. \IaA. I understand as an Owner-Builder it I sell the property tor which this permit is issued, I may be held liable for any linancial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or materials. U_49. I understand I may obtain more intormation 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 lndustrial Accidents. I also undersland 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. \)_C"-t O. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am lhe party legall van d linanciall y responsiblq lor proPos5 oaz !t-nstr ron clivity at followl YzzaTaddres Q_Ql I .l agree that, as the party legally and f inancially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern OwnerBuilders as well as employers. l)eJZ+agree to notify the issuer ol this lorm immediately of any additions, deletions, or changes to any ol the information I have provided on this form. Licensed contraclors 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 lor you to understand that il an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable lor damages. lf you obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible for verifying whether or not those Contractors are properly licensed and the slatus 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 lor issuing the pe it. lvole: A copy of the property owner's driver's licensc, rm notarization or other veritication acce obe ted when the it is owner na Signature ol Property Own Date Print name of Owne lr l,.Ir'r AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Nolice lo Property Owner. the execution ol which I understand is my personal responsibility. I hereby aulhorize the following person(s) to act as my agent(s) to apply lor, sign, and file the documents necessary to oblain an OwnerBuilder Permit lor my project. Scope of Construction Project (or Descriplion of Work) Project Location or Address Name ol Authorized Agenl Address of Authorized Agent ldeclare under penalty of perjury that I am the property owner for the address listed above and I personally filled out lhe above inlormation and certify its accuracy. Property Owner's Signature Date Print Name of Owner Nole: A copy ol the owner's driver's license, torm notarization, or olher verilication acceptable to the agency is required to be presented when the permit is issued to verity the property owner's signature. SANTA ANA CITY COUNCIL mouldo@sa.ta ana oro Mayor Pro Te6. Wad ? mrmrlr.ez@sanla.a.. oro Vicenre Sarmronlo vsa.rrxento(asanla.ana.aI!ir9lp!!@l34la3!r.!!q Phone Number ol Aulhorized Agenl:_