10198832 - Permit - Laserfiche WebLink

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7 a a licensed subcontraclors 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. [,4'\ a. t understand as an OwnerBuilder if I sell the property for which this permit is issued, I may be held liable for any Iinancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction delects in the workmanship or materials. CILn. , understand I may obtain more in{ormation regarding my obligations as an "employer" 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 conlact the Calilornia Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors. A- IA ,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 and Iinancially responsible lor proposed construction activity at the following address /l tlA r.l agree that, as the party legally and financially responsible {or this proposed construction activity. I will abide by" all applicable laws and requirements that govern Owner-Builders as well as employers. k LlLtz I agree to notify the issuer of this torm immediately of any additions, deletions, or changes to any of the inf ormation 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 musl be completed and signed by the property owner and returned to the agency responsible lor issuing the permil. ,Vote.' A coDV of the proDertv owner's driver's license. form notarization. or other tion acceDtable to the aqencv is required to be ted when the Dermit is Signature of Property Owner 144 *^Date: b Print name of Owner V\A YLS a_ AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner. the execution oi which I understand is my personal responsibility, I hereby authorize the lollowlng person(s) to act as my agent(s) to apply 1or, sign, and file the documents necessary to obtain an Owner-Bullder Permit for my project. ,/ Scope ol Construction Projecl (or Description rtrWork) Project Location or Address Name of Authorized Agent Address of Authorized Agent Phone Number of Authoriz Agent ldeclare under penal f perjury that I am the property owner d I personally lilled out the above nforrnatron and ce its accuracy Property Owne gnatu re Date Prlnt N bf Owner Note copy ol the owner's driver's license,notarization, or o tion acceptable to the agency is required to ted when the permit is issued to ty the properTy o signature, 3 r4 ?,.ra SANTA AN COU NC IL he address listed above mou do@sanla ana.oro Mayor Pro Tem. Ward 2 mrman nez@sanla.ana.oro vsarm entc@sanra a.a.ro isoloro@santa-ana oro P Davd Beiav,des dbenav des@santa-a.a oro Nrlieoas@sanla'ana oro s!naiero@sa.la ana.oro issued to verifv the DroDertv owner's sionature. L