10199912 - 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 Contractor. lt l&::X. t understand as an OwnerBuilder if I sell the property for which this permit is issued, I may be held llable for any finidncial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or materials. tltLtW'9. I understand l may obtain more information regarding my obligations as an "employer" f rom the lnternal Revenue 66rVice, the United States Small Business Administration, the Calilornia Department of Benelit Payments, and the California Division ol 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 lor more inlormation about licensed contractors. Wa address: I am aware ol and consent to an Owner-Builder building permit applied for in my name, and understand that I am legally a nd f inan ally r ons tor propos ed construction ctiv at the fol rng ob0 )fu,,, all applicab )&o,^ ihforlnation agree that, as the party legally and financially responsible for this proposed construction activity, lwill abide by le laws and requirements that govern Owner-Bullders as well as employers. gree lo notily the issuer of this lorm immediately of any additions, deletions, or changes to any of the 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 lor 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. ll you obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible Ior verifying whether or not those Contractors are properly licensed and the status of lheir workers' compensation insurance coverage. Betore a building permit can be issued, this form musl be completed and signed by the property owner and returned to the agency responsibfe lor issuing the permit. Arore.' A copv of the Dropertv owner's drivet's license. form notarization, or other veritication acceptable to the aoencv is reouired to be presented when the permit is to the owner nature. Signature of Property Print name of Owner Owner Date //)a 0 5 AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which lunderstand is my personal responsibil,ty. I hereby authorize the lollowing person(s) to act as my agent(s) to apply for. sign, and file the documents necessary to obtain an Owner'Builder Permil for my project. Scope ol Construction Project (or Description of Work) Projecl Location or Address Name oJ Authorized Agent Address of Authorized Agent Phone Number of Authorized Agent I declare under penalty ol perlury that I am the property owner for the address listed above and I personally iilled out the above information and certify its accuracy. Property Owner's Signature Date Print Name ol Owner Note: A copy of the owner's driver's license,lorm notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verily lhe property owner's signature. SANTA ANA CITY COUNCIL mouldoaAsanla-ana oro lrayor Pro Tefi. Ward 2 mrmanine2@sarla ana oro Vrcenre Sarmienlo vsarmienlo@sanra anaoro isolorio@santa'ana.oro P. David Beravides dbâ‚¬navrdes@sanra-ana oro ivilleoas@santa'ana oro $ naiero@$nta-ana oro