20163643 - Permit (4) - Laserfiche WebLink

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licensed subcontractors and the number of slructures does not exceed lour within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. h> 8. I understand as an Owner-Builder if I sell lhe property for which this permit is issued, I may be held liable for any fina9cial or personal injuries sustained by any subsequent owner(s) that result from any latent construclion delects in the wolkmanship or materials. 5) g. t understand I may obtain more inlormation regarding my obligations as an "employef'from the lnternal Revenue Service, the Uniled States Small Business Administration, the Calilornia Department of Benefit Payments, and the Calilornia Division of lndustrial Accidents. I also understand I may contact the Calilornia Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more inlormation about licensed contractors. .10. I am aware ol and consenl to an OwnerBuilder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the rollowing address (4 t t. I agree that, as the party legally and linancially responsible for this proposed construction activity, I will abide by all'applicable laws and requirements that govern Owner-Builders as well as employers. Sl lZ. 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 any financial loss you may sustain as a resull ol a complaint. Your only remedy against unlicensed Contraclors may be in civil court. lt is also important for you lo understand that if an unlicensed Contractor or employee ol 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 verilying whether or not those Contraclors are properly licensed and the status of lheir workers' compensation insurance coverage. Belore a building permit can be issued, this lorm musl be completed and signed by the property owner and returned to lhe agency responsible tor issuing the permil. ,Vole.' A copv of the propertv owner's drivet's license, torm notarization. ot other vetification acceDtable to the adencv reouired to be Dresented when the Dermit is,s issued to verifv the v owner's sionature. /-,4 a-lo-/ )Signature of Property Owner Print name of owner f tl r4lt C fr .f F47H Date r AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNEB'S BEHALF Excluding the Notice to Property Owner. lhe execulion of which I undersland is my personal responsibility, I hereby authorize the iollowing person(s) to acl as my agent(s) lo apply ior, sign. and iile lhe documents necessary to obtain an Owner-Builder Permit for rny project. Scope of Construction Proiect (or Description o, Work) Project Location or Address Name ol Authorized Agent Address of Aulhorized Agent Phone Number of Authorized Agent I declare under penalty of perjury lhat 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 Dale Pnnt Name ol Owner Note: A copy ot lhe owner's driver's license, form notarization, or olher verification acceptable lo the agency is required to be presenled when the permit is issued to verify the prcpedy owner's signalure. SANTA ANA CITY COUNCIL e!!.0!@r4!la;r!! qc Mayor Pro Tem. Ward 2 aman'ne2@san!a.ana.o.o Vice.te Saimenro Bme.to@snla-ana oro 6oro.ro@snr3'ana oro P. Oavd Bâ‚¬navdes !!e!ryce!@$!E:4i ^'lleoas(asd' :a a, a o'o sr -de,o6sa' la.a.a o(