309 & 311 N Main St - URM Report

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a ress: 11. I agree that, as the party legally and financially responsible for this proposed construction activity, lwill abide by icable laws and requirements that govern Owner-Builders as well as employers 12. I agree lo notify the issuer of this form immediately of any additions, deletions, or changes to any of the rmation I have provided on this form Llcensed contiactors are regulated by laws designed to protect the public. lf you contract with someone who does nol have a license, thp Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a resull of a complaint. Your only remedy againsl unlicensed Contractqrs may be in civil court. lt ls also important for you to understand that if an unlicensed Contractor or employee of that individual or tirm 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 Mrether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, th must bE completed and signed by the property owner and returned to the agancy responsible for i permit. Nofe.' A coov of the ,rooedy owner's d vet's license. or verific tion the ,s th ,s ,s the Signature of Property Prlnt name of Owner Owner Datei 2o AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excludlng th€ Notice to Pmperty Owner, the execution ofwhich I understand is my personal responsiblllly, lhereby authorize the following person(s) to acl 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 Descrlption of Work): Project Location or Address 3oq L)\dq \O AceeT-3s;lA NrJ+, Cft Name of Authorized Agent:-SLtureft-qalol Address of Authorized Agent: \Lt - 3\Qoz-8g I declare under penalty of pe.jury that Information and certify its accuracy. property owne. for the address llstod above and I personally filled out the above Property Own6r's Signature: Priot Nane of owner f€ ,^",-I44 Nolo: A copy of lhe ownels drl ense, form notarizallon, or verlfication acceptable lo the agency is roquirod to be prcsentod when the permil is issued ,o vedfy ahe properly owner' PLlnkWPsl/Counter Actlvity/Assembly Bills/Notlce to Property Form O3-13-2O14 signature. SANTA ANA CITY COUNCIL am n.. U_ ,4_9. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any fir{ancial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in lhe wdhstanshio or malerlals.\,/ 4 g. t understand I may obtain more information regarding my obligations as an "employe/' from the lnternal Revenue Seffvice, the Uniled Slates Small Business Administration, lhe California Department of Benefit Payments, and the California Division of lndustrial Accidents. I also understand I maycontact the California Contractors' State License Board (gS\B) at 1 -800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors.'v' /l 10.1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am thd party Iegally and financially responsible for proposed construction activity at the following tl,-t-// I Phone Number ofAuthorlzed Agent: Mquc A. nrldo i 5l TJ"F! i vl.GinF Soni.nlo i r.dde M..rll!! i ^ngdrr armzox i p o'idg,€tid.s i RorD F.r.rM.yot : U.tt,Prot F.w.d6 : Wlrd I j w6'd 2 i w.r6 3 i W",l o j Wr,oSl9'rrdoro.-r.{..ao : SI!Adg@!ig!:rOrg! i vssm6^loou,,E-.m @ : MrAdh.r6.a.h-"na m : a rmr@6u,xFMm i o8.E\id6ordr.-r.i m : gnSrg@{aL@&!O