20165645 - Permit (2) - Laserfiche WebLink

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licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. -T'hf 8. lunderstand as an Owner-Builder if I sell the property for which this permrt rs issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. Ttt 9. I understand I may obtain more information regarding my obligatio;rs 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 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. LtO I am aware of and consent to an OwnerBuilder building permit applied for in my name, and understand that I am the party I lly and financially res nsible for proposed construction gtivity a t the fo lo.a llowing addre .;A Y* 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. t'd- 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 result of a complaint. 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 verifying whether or not those Contractors are properly licensed and the status of their workers' com pensation 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 p ermit. ,Vole.' A copv of the propetty owner's driver's license, form notarization, or other veritication acceDtable to the aoencv is reouired to be ented when the Dermit is Signature of Property Owne, / )fr*"q W Date: fu-tl - 2Ol p 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 Ior, sign, and flle the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work) Project Location or Address Address of Authorized Agent Phone Number of Authorized Agent I declare under penalty of perjury that I am the property owner for the address listed above and I personally fllled out the above information and certit its accuracy. Properly Owner's Signature Date Print Name of Owner: Note: A copy of the owner's driver's license, form notarizalion, or other verification acceplable to the agency is required to be prcsenled when the permit is issued lo verify the property owner's signature. SANTA ANA CITY COUNCIL moulrdo@sants-5na oro Mayo. Pro Teo. \tard 2 mrmanr.ea@sa.la.ana.ora isolono@sa.la-a^a o.. P D.vd Bâ‚¬naudes dben.vd6@s.nla ana oro NLlleas@s.nra-ana oro slrnaE.o@e.t.-.na.orc issued to verifu the propertv owner's sianature. Print name of Owner Name of Authorized Agent: