10285840 - Permit - Laserfiche WebLink

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rJcDM 8. I understand as an Owner-Builder if I sell the prrperty for which this peJ[nit is issued. I may be held liable for any financial or personal injuries suslained by any subsequent owne(s) that r6sdit from any latent construction defects in the workmanship or materials. \ ClJl e I understand I may obtain more informalion regarding my obligations as an "employer" from the lnternal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payrnents, and the California Division of lndustrial Accidents. I also understand I may contact the Callfornia Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. U,lJllO.I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party leg address: ally and financially responsiq e for proposed construction activ ity at the following ..,c ,l I }L At'l'111.1 agree that, as the party legally and fi6ancially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. tt)il'tZ. t 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' compensation insurance coverage. form notarization. or other verification acceDtable to the aqency is required to be presented when the pemit is issued to verify the propeftv owner's siqnature Signature of Property Owner Date o-+/ zq ls' Print name of owner ( . r I a. Nu r^lus 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 flle the documents necessary to obtain an Owner-Builder Permit for my proiect. Scope of Construction Project (or Descriplion of Work) Name of Authorized Agent Phone Number of Authorized Agent: I declare under penalty of periury that I am the property owner for the address listed above and I personally tilled out the above information and certify its accuracy. Property Owneis Signature Print Name of Owner: Date Note: A copy of the owner's driver's license, lorm nolari2ation, or other ve ficalion acceptable to the agency is requied to be presented when the permit is issued to verify the propetry owner's signaaure. PLink:WPs1/Counter Activity/Assembly Bills/Notice to Property Form 03-13-2014 SANTA ANA CITY COUNClL MPvlrdoiosanla-ana orc Mayor Pro Teh Wad 6 sr,naâ‚¬.o6sanra'ana oro V$m e.loAsanla.ana oro MMirlrnez@sa.!a ana oro AAaâ‚¬zc!aOsanra.a.a oro P Oard Aenasdes OBenaMdes@sa.la ana orq RRevnaOsanra-a.a oro 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. lVote-' A coDv of the propertv owner's driver's license, Project Location or Address: Address of Authorized Agent:_