10189183 - Permit - Laserfiche WebLink

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/ji) 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s)'th~t result from any latent construction defects in the ~anship or materials . ~9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service , the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board jCSbf3 ) at 1-800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. '!!f!!_10. 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 responsib e for proposed constfi.l,l.ction ac.!1¥ity at th follo~g _ ~-, '1./J U address: ~( 0 ( ? -.J-.,1) ->, rr//lA C ?'/ c = / ........ 1 {i!j)_ 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by ~plicable laws and requirements that govern Owner-Builders as well as employers. ( ~ 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provid ed 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 civil court. It is also important for you to understand that if an unli censed Contractor or employee of that individual or firm is inj ured while working on your property, you may be held liable for damages. If 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 t heir workers' compensation insurance coverage. Date: _/.~~~;(_c::,_,L-/j-'------'1/ b_ l ( AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby auth orize the following person(s) to act as my agent(s) to apply for, sign, and file the documents ne cessary to ob tain an Owner-Builder Permit for my project. Scope of Construction Proje ct (or Des criptio n of Work):. _______________________ _ Project Locati on or Address:---------------------------------- Name of Authorized Agent:---------------------------------- 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 informatio n 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 ANA 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 AAmezcua@santa-ana .org OBenavides@santa -ana.org Roman Reyna Ward 5 RReyna@santa -ana.org Sal Tinajero Ward6 STinajero@santa-nna.org