10293130 - 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 p ormed under contract with a licensed general building Contractor 8. I understand as an Owner-Builder il I sell the property for which this permil is issued, I may be held liable for any fi n a ncta I or personal injuries sustained by any subsequent owner(s) that result lrom any latent construction defects in the workmanshi p or materials I understand I may obtain more information regarding my obligations as an "employei'from the lnternal Revenue Service, the United States Small Business Administration, the California Department of Benelit Payments, and the California Division of lndustrial Accidenls. I also understand I may contact the Cali{ornia Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed conlractors.nl/( U U lo.l am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legal va'3 nd f inanciall v po nsible fo r oroe nstru n acti at the fol 0address dL,, .S s I agree that, as the party legally and financia ly responsible for this proposed construction activity, I will abide by all applica d/r* 'informatio ble laws and requirements that govern Owner-Builders as well as employers agree to notily the issuer of this form immediately of any additions, deletions, or changes to any ol the n 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' Slate License Board may be unable to assist you with any linancial 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 lor you to understand that if an unlicensed Contractor or employee of that individual or lirm is injured while working on your property, you may be held liable Ior 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. Betore a building permit can be issued, this lorm must be completed and signed by the property owner and relurned to the agency responsible for issuing the per mit. /Vote,' A copv of the property owner's driver's license, form notarization, or other verification acceptable to aoencv is reouired to be Dresented when the Dermit is wner nature. Signature of Property Owne Date:3 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 ol Construction Project (or Description of Work) Name of Authorized Agenl Add.ess of Autho. zed 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 certily its accuracy. Property Owneas Signature Date Print Name of Owner Note: A copy ol the owner's driver's license, lorm notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verily the property owner's signature- ] . 'l:: .. . '.i] ' i:.. .:' ll i: ::.) 'i i., : SANTA ANA CIIY COUNCIL 0&1149@lada:a!r.or9 Mayor Pro Tem. Ward 2 m martinez@santa-ana.oro Vrcenre Samienro vsarmienlo@sanla.ana.oro isolor o@sanla'ana oro P David Benavides dbenavides@santa-ana.oro ivlleoas@santa'afaoro snnaiero@sanlaana.oro Project Location or Address: Phone Number of Authorized Agent