10291383 - Permit - Laserfiche WebLink

Home Browse Search

. I understand as an Owner-Builder if I sell the property for which this permit is issued , I may be held liable for a ny I or personal injuries sustained by any subsequent owner(s) that result from any latent constru ction defects in the anst")ip or materials. 9. I_ understand I may obtain more information regarding my obligations as an "em ployer" from the Internal Reven ue e , the United States Small Business Administration, t he California Department of Benefit Payments , and the rnia Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Boa r d (CSLB) at 1-800-321-CSLB (2752) or www.cslb .ca.gov for more information about licensed contractors. 0 . I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am rty legally and financially responsible for proposed construction activity at the foll owing s: ___________________________________________ . 1 . I agree that, as the party legally and financially responsible for this proposed co nstruction activity, I wi ll abide by licable laws and requirements that govern Owner-Builders as well as employers . . I agree to notify the issuer of th is form immediately of any additions , deletions, or changes to any of the ation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If 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 ci vil court. It 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 . If you obtain a permit as Owner-Builder and wish to hi re 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 property owner and returned to the agency responsible for iss · the permi · pertv owner's driver's license, form notariza ble to the resented when the ermit is issued to ver, /1 ;· / Signature of Property Owner __ ~...,,rJ--1,,L'"4.J.-+-iL...S:C--'------+-l---":........,_ __ Date: I l LJ 5'-f tL LuWo 7 AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, th e exec ution of which I und e rstand is my personal responsibility , I hereby a uthorize the following person(s) to act as my agent(s) to apply for, sign , and file the documents necessary to obtain an Owner-B uilder Pe rmit for my project. Scope of Construction Proj ect (or Descripti on of Work):. _______________________ _ Project Location or Address:---------------------------------- Name of Authorized Agent:---------------------------------- Address of Authorized Agent:. ________________________________ _ Phone Number of Authorized Agent:------------------------------- 1 declare under penalty of perjury that I am the property own e r for the address listed above and I personall y fill ed out the above information and certify its accuracy. Property Owner's Signature: ______________________ Date: _________ _ Print Name of Owner: ___________________________ _ 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:WP51/CounterActivity/AssemblyBills/Notice to Property Form 03-14-2016 Vicente Sarmiento Michele Martinez SANTA A NA CITY COUNCIL Angelica Amezcua Ward3 P. David Benavides Ward 4 Miguel A. Pulido Mayor MPulido@santa-ana.org Mayor Pro Tern, Ward 1 Ward 2 VSarmiento@santa-ana.org MMartinez@santa-ana.org Mmezcua@santa-ana.org DBenavides@santa-ana.qrg Roman Reyna Ward 5 RReyna@santa-ana.org Sal nn~jero Ward6 STina fero@santa-ana.org