10296336 - 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)/l A. t understand as an Owner-Builder if lsell the property for which this permit is issued, I may be held liable for any ,f,n"ai'cial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 0 ,/ g. lunderstand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue '3e?Vce, 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. 04,0 'the party address: I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am le and tnanc ly re nsible for p op cons n activ ity at lhe fo tng 0 / f .I agree that, as the party legalty and financially responsible for this proposed construction activity, I will abide by cdlfYpplicable laws and requirements that govern Owner-Builders as well as employers. 0tl lZ. t agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the {nfo"rmation 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' 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. /Votej A coDv of the DroDertv owner's driver's license- form notarization, or other verification a cceptable to the aqency is required to be presented when the permit is rssued (o verify the owner's sionature. Signature of Property o*n", 0,*-/,'7/ z /r r-,+---2 Print name of Owner 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 for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Pro (or Description of Work) Project Location or Add Name of Authorized nt Address of Authoriz Agent Phone Number of A orized Agent: alty of perjury that I am the prope owner for the address I above and I personally fll.)ed out the above rtify its accuracy Property Owne Signature Date Print Name er: Note: A y of lhe owner's driver's form notarization, or Yerification accepta to the agency is required to be when the permit is issued Yerify the property signature. Pliil('!n'P5iiCo!.ieiAc!vily:Assenb lRtirsrN.r.e t. Pr.Fâ‚¬ry SANTA ANA C COUNCIL mo!lido@sanla-ana oro Michete Ma.l nez Mayor Pro Tem Ward 2 mimaa{inez@santa-ana.o.o V.ente Sarmenlo vsarm e.loasa.la a.a ors rsolonorosanla-a.a oro ivl eoas@santa'ana.oro sl naiero@santa ana.oro Date: I declare under information and