10293432 - Permit (2) - Laserfiche WebLink

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8. I understand as an OwnerBuilder if I sell the property lor which this permit is issued, I may be held liable for any financial or personal lnjuries sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or materials. ACY. )9. I understand I may obtain more inlormation 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 ol 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 contraclors. licensed subcontractors and the number of slructures do,es not exceed four within any calendar years, or all of the work is perf ormed under contract with a licensed generallLitdfi'g Conlractor. e4 tfie da legally and tinanciaf,y re 10. I am aware of and consenl to an Owner-Builder building permit applied for in my name, and understand that I am rty nsibl for pro sed constructi ivity a followingn addresse\ -all appl '1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by icable laws and requirements that govern Owner-Builders as well as employers. ab" , agree to notity the issuer of this form immediately ol any additions, deletions, or changes lo any ol the inf 6rmation I have 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 ol a complaint. Your only remedy against unlicensed Contractors may be in civil court. ll is also important lor you to understand that if an unlicensed Contractor or employee ot thal individual or firm is injured while working on your property, you may be held liable for damages. lf you obtain a permit as OwnerBuilder and wish to hire Contactors, you will be responsible for verifying 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 relurned to the agency responsible lor issuing lhe permit. /Vore.' A copv of the propertv ownet's driver's license. fom nota zation. or other rilication acceDte ble to the a ,s uired to be sented wh n lhe Dermil isoencvreo issued lo theven Signature of Property Owner Date 7- s- t4 Print name of owner b AUTHORIZATION OF AGENT TO ACT 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 lor, sign. and file the documenls necessary to obtain an Owner-Builder Permit for my project. Scope ol Construclion Projecl (or Description of Work) Project Location or Address Name ol Authorized Agent Phone Number of Authorized Agent ldeclare under penally of perjury that I am the properly owner for the address listed above and I personally filled out the above information and certify its accuracy. Property Owner's Signature Date Print Name ol Owner Note: A copy ol the owner's d ver's license, torm notarizalion, or othet verilication acceptable to lhe agency is required to be presented when the permit is issued to verily the propefty owner's signature. SANTA ANA CITY COUNCIL aq1lil!@I3!ja:3!3.9rc Mayor P.o Tem. Ward 2 fr mnr.er@santa-ara oro !$.!]f-c!i!.rir-erljl:n:-ail, ]l!qa]es?!B:!! P Oavld Benaudâ‚¬s dbenav'dâ‚¬s@sanla.ana oro ivr!9ce@$dr:4a-qg gErie!!@!a!E:a!r.q9 Address ol Aulhorized Agent:_