10296522 - Permit - Laserfiche WebLink

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address (-\U I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all fi!6able lais and requirements'thai govem Owner-Builders as well as employers. ^\. )(*\-l Z. I 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 llnancial loss you may sustain as a result of a com plaint. Youronly remedy against unlicensed Contractors may be in civil court. ltisalso important for you to understand that if an unlicensed Contractor or employee ofthat individual orfirm is injured while working on your property, you may be held liable for damag es. 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 property owner and returned to the agency responsible for issuing the permit. /Votei A coDV of the Dropeftv owner's driver's license, form notarization, or other verification acceptable to the aqency is required to be presented when the permit is issued to verify the Dropertv owner's sienature..5--}>-tlSignature of Property Owner Date Print name of owne, CAJ.y''OJ AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF xcluding the Notice to Property Owner, the execution of which I understand is my personal responsibiljty, I hereby authorize the owing person(s) to act as my agent(s) to apply for, sign, and file the docum ts necessary to obtain an Owner-Builder Pe t for my p ld S of Construction Proj (or D ription of Work) Project cation or Add SS Name of A orl nt Address of rized Agent Phone N Authorized Aqent: under Ity of perjury that I am the imation an dce its accuracy roperty Owner's Sig re Print Name of Owner: Note: A copy of the own be presented when the p PLink;WP51 /CounlerActivity/blyBillslNotice to Properly Form personally out the above Date icense, form notarization, or er ation acceptable to the agency is to verify the propefty owne ature. to n-l SANTA ANA CITY COUNCIL owner the address listed above a dris it is .noulidorosanla-ana.oro vicente Sarmie.to 6arm e.torosanla -ana oro solono@safta-ana.orc !villeas@sanla-ana.oro sllnaero@santa-ana oro N :<)9.-l understand I may obtain more information regarding my obligations as an "employer'from the lnlernal 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 contact the California Contractors' State License Board (CSLB) at 1 -800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors.tl CIrc I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party -ISgally and financially responsible for proposed construction activity at the following required Mayor Pro Tem, Ward 2 m manrnezrosanla-ana oro P. Dav d Benavides dbenaudes@sanla-ana.oro