10397075 - Permit - Laserfiche WebLink

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0L u. , understand as an Owner-Builder if I sell the property for which this permit is issued, I may bâ‚¬ hetd tiabte for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects ln the workry)anship or materials. -{t. tunderstand I may obtain more information regarding my obligations as an 'employed from the lntemal Revenue Servic,e, the United States Small Business Administration, the California Departmâ‚¬nt of Benefit Payments, and the California Division of lndustrial Accidents. I also understand I may contact the Califomia Contractors' State License Board (CSL9 at 't{00-321-CSLB (2752) or www.cslb.ca.oov for more informatjon about licensed contractors. M , O I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: Ma, I agree that, as the party legally and financially responsible for this proposod constructjon activity, I witt abide by all applicable laws and requirements that govem Owner-Builders as well as employers. Mr. ,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 conlractors are regulated by laws designed to protect the public. lf you contract with someone who does not have a license, the Conttactors' 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 rasponsible 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 thâ‚¬ agency responsible for issqing the permit, ivofei A copv of the prooeftv ownels drivefs license. form notarization.or other verification acceotable to the aaencv is reduired to be Dresenled when the oermit is to e s ture. Signature of Property Print name of Owner Owner Date {-aL-tq cfol '. d. t(fKt.r.{ AUTHORIZATION OF AGENT TO ACT ON PROPERW OWNER'S BEHALF Excluding the Notice to Property Owner, the execution ofwhich I understand is my personal responsibility, I hereby authorize thefollowing person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an O,'rner-Builder permit for myproj6ct. Scope of Construction Project (or Description of Work)lnstallation of steel racki ng throughout warehouse Pro.j ect Location or Address: 1 1 5 E Alton Ave, Santa Ana, CA 92707 Name of Authorized Ag ent: J?cob Stephens Phone Number of Authorized egent -916471'9822 I declare under penalty of perrury that I am the prope rty owner for the address listed above and I personally filled out the above informauon and certitr/ its accu Property Owne/s Signa Date -aJr-n Print Name of Owner l.a"A Note: A copy of the owner's ddyels license, form notaization, or oahet veification acceptoble to the agency is requlred tobe prcsanted when the psrmit is issued to verffy the propedy owne,,s signature. PLhk:WP51/Counter Activity/Assembty Bils/f,lotjce to property Form O3-13-2014 SANTA ANA CITY COUNCIL Address of Authorizeo asent: 1 1 5 E Alton Ave, Santa Ana, CA 92707 Ms!â‚¬r^ pd'do I sd n..ih i v(EoLl i1n5o i M-.,. r1n* i ^ae6rc. a,ll.EE i p. D.{d B,Eud6 i Rom.n R.ynsM.ys : M.yaPorf.w.d6 i._ w:,! ! ; yrr&6 2 ! - wril i -*;. j wlr:.r,F'jr''odiqG_.8.e : sr'tu.66!&r.-.. @ i vs!fr6b@t ^E.i.m i urantor,o*nrrna.oo , Aa,'rarosnao m i Ogr4.Eocl.orroL..."s j nnmacoarne m