10196587 - 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. Q[a., lunderstand as an Owner-Builder if lsell the property for which this permit is 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. !ftr[_- g lunderstand lmayobtain more information regarding myobligations as an "employel'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.qov for more information about licensed contractors. ?r{L ,O.l am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally address: and financial responst ble for p CO nstruction activity at the foll owtn 4*zoâ‚¬ 4L 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. &L-],r.| 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. Before a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency resp onsible for issuin g the pe rmit. /Vote.' A copy of the property owner's driver's license, form notarization or other tion it is issued fo the Signature of Property Own Date bt 3a t7 Print name of Owner N 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 Project (or Description of Work) Project Location or Address Name of Authorized Agent: 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 filled out the above information and certify its accuracy. Property Owner's Signature Date Print Name of Ownerl Note: A copy of lhe owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permil is issued to yerify lhe property owner's signature. SANTA ANA CITY COUNCIL wner's mou do@sanb-ana oro Mayor Pro Tem Ward 2 m ma,lhezrOsanla ana.oro Vicente S6m enlo vsarhrenro@sa.ra-3n3 0ro solono@sanla-a.a oro P Davd Benavrdes dbenavdes@sa.la-ana oro i! leoas@santa-ana oro sli.alero6'sanla-ana oro 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.