20153163 - Permit - Laserfiche WebLink

Home Browse Search

t.hI \ 8. I understand as an Owner-Builder if I sell 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. l,lLn 38ri"" , I understand I may obtain more information regarding my obligations as an "employer'' from the lnternal Revenue the United States Small Business Administration, the California Department of Benefit Payments, and the ia Division of lndustrialAccidents. I also understand I may contact the California Contractors' State License Board at 1-800-321-CSLB (2752) orwww.cslb.ca.qov for more information about licensed contractors. Californ (csLB) /n- to iile partv I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am legally and financial ly respon sible for proposed construction at the followi (-address 11. I agree that, as the party legally and financially responsible forthis proposed construction activity, lwillabide by ,licable laws and requirements that govern Owner-Builders as well as employers. JJJ2.l agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the irifrmation 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 must be completed and signed by the pro perty owner and returned to the agency responsible for issuing the permit. /Vofe;A copv of the propertv owner's driver's license. Signature of Property Print name of Owner Date: iA AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execulion 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 Project Location or Address: Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. PLink:WP5'f /Counter Activity/Assembly Bills/Notice to Property Owner & Authorization Form 06-2012 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. Properg Owner's Signature: Date:_ Print Name of Owner: