10193616 - Permit - Laserfiche WebLink

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licensed subcontractors and the number of structures does not exbeed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. =? g. I understand as an OwnerBuilder if I sell the property lor which this permit is issued, I may be held liable ror any financial or personal injuries sustained by any subsequenl owne(s) that resull lrom any latent construction defecls in the workmanship or materlals. I? g. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Service, the United States Small Business Administration, the California Department ol Benefit Payments, and the Calilornia 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 lor more information about licensed contractors. +Y 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party address: leqallv and financiallv resoonsible lor5t jc>A LeJ (o'\''r a>\ proposed.conslruqtion activity at the f ollowing$avr\o- Qrro- C,A I$?d= ^1,)-l.-!-1 1 I agree that, as the party legally and financially responsible lor this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. 8-lz.l agree to notify the issuer ol this form immedialely ol any additions, deletions, or changes to any of the inlormation 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, lhe Contractors' State License Board may be unable to assisl you with any Iinancial 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 il an unlicensed Contractor or employee ol that individual or lirm is injured while working on your property, you may be held liable for damages. lf you obtain a permit as OwnerBuilder and wlsh to hire Contactors, you will be responsible for verilying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Belore a building permil can be issued, this lorm musl be completed and signed by the property owner and returned to the agency responsible for issuing the permit. /Vore.' A coDv of the DroDertv owner's driver's license. form notarization. or other veritication acceDla ble to the aaencv is reouired to be Dresented when the Dermit is issued to the Signature of Property Owner o ers sl nature. Date G-OZ-11 Print name of Owner f 4r-c\ AUTHOBIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding lhe Notice to Property Owner. the execution o, which lunderstand is my personal responsibility, lhereby aulhorize the lollowing person(s) to act as my agenl(s) to apply lor, sign, and lile the documenls necessary to obtain an OwnerBuilder Permit lor my project. Scope of Construction Project (or Description of Work)oo< -r qobg () l()Tt1 =* Sov^r{c--Qv-\6- C)A <t 21o=Project Location or Address Name ol Authorized Agent: Address ol Authorized Agent )bo8 () fon{ =f 5o.nLo- Avro- etAnD)o q o' Phone Number ol Authorized Agent 1G-BoOL ldeclare under penalty of perjury thal m the properly owner I he ress listed above and I personally lilled out the above information and certify its accurac Properly Owner's Siqnature Prinl Name of Owne,. lE t Ylfr c-\ Ct ?\ a,s.-,errot*- Note: A copy ol the owae4 drivei's ticense, ioin noiiiiation, or otier verrticaion acceptable to the agency is required to be presented when the permit is issued to verity the prcperty owner's signaturc. SANTA ANA CITY COUNCIL l@l'.,.@snla..m oro Mayor Pro Tem. !Jard 2 nmnrne2@enra ena oro Vrcente Sumr€nlo YE!q94e@gqS:e!r,.el9 Eoloro@sanla.ana or. P Oavd Benavrdes dbenavld.s@enta.ana o.d Mlle.slasanta-ana oro sr.ae,.Os..ra a.3..! Dar., A'2 B -/7