10196675 - Permit - Laserfiche WebLink

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licensed subcontractors 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 Cont&ctor. 1,C A. t understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any finldncial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 11g I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue S6ivice, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of lndustrial Accidents. lalso understand I may contact the California Contractors' State License Board (CSLB) at 'l-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. .-7 n/r thb/pa 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am rty leoallv and financiallv re4.t'19 '{- lk}S ible for proposed construction activity at the following address:ce- I 7./ ll I agree that, as the party legally and financially responsible for this proposed construction activity, lwill abide by allApplicable laws and requirements that govern Owner-Builders as well as employers. TA,r.tagreetonotifytheissuerofthisformimmediatelyofanyadditions,deletions,orchangestoanyofthe 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 Iicense, 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 impodant 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 property owner and returned to the agency responsible for issuing the permit. Nole.'A coDv of the orooertv owner's driver's icens form notarization, or other verification a cceDtable to the aqencv is required to be presented when the permit is issued to verifv the owner's sidnature Signature of Property Owner Date: b 3 Print name of Own"r 'I(rxrrJer P/'1N AUTHORIZATION OF AGENT TO AGT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution 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 Work) Project Location or Address: 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. Date Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presenled when the permit is issued to verify the propedy owner's signature. ir ^, .-,,;a :..^.. irr _... i-.:; .tr,.a .'!.:,..i_ i, r;-i! i -. a-r -: lll'a SANTA ANA CITY COUNCIL mpul do@santa-ana oro Mayor Pro Tem, Ward 2 mimarlinez@sanla-ana oro Vrce.te Samle.ro vsa.m enblasanta-ana oro iso orio@sania-ana.oro P Oavid B€navdes dbenavrdes@sanla-ana oro villeoaslasania-ana oro strnaiero@sa.ta'..a o.o Name of Authorized Aoent: Property Owner's Signature: Print Name of Owner: