2833 S Fairview St Unit# F - Misc. Permit

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licensed subcontractors and the number of structures does not aiceed four within any calendar years, or all ol the work is performed under contract with a licensed general building Contractor. @-A 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 owne(s) that result from any latent construction delects in the workmanship or materials. 'W_9. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division oJ 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 for more information about licensed contractors. '&-'to fiE pa.tv address: I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am leg all nd f inancially res nsible for proposed construction activity at the f ollowin UN tr --1() fu,.1 agree thal, as the party legally and financially responsible lor thls proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. -fu, I agres to notify the issuer of this lorm immediately of any additions, deletions, or changes to any of the 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 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 coud. lt is also important for you to understand that if an unlicensed Contractor or employee of that individual or lirm is injured while working on your property, you may be held liable tor damages. lf you obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible for verilying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. form notarization, or other verification acceDtable to the aoencv is reouired to be Dresented when the Dermit is issued to verifv the Dropertv owner's sianature- Signature of Property Owner Date AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which Iunderstand is my personal responsibility, I hereby authorize the iollowing person(s) to act as my agent(s) lo apply for. sign, and file the documents necessary to obtaln an Owner-Builder Permit for my project. Scope of Construction Prolect (or Description of Work) Project Location or Address Name of Authorized Agent Address of Authorlzed Agent I declare under penalty of perjury that I am lhe propeny owner for the address listed above and I personally filled out the above information and certify its accuracy. Property Owner's Signature Dale 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- SANTA ANA CITY COUNCIL moulldo@sanra.ana.or. lvlayor Pro Tem. Ward 2 m mart,nez@sanla.ana oro V cente Sar.n erto vsarm enlo@sanla.ana.oro isoloio@sanla-ana.oro Belore 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. A/ote.' A copv of the DroDertv owner's driver's license. Print name ol Own" Phone Number ol Authorized Agent: P Dav,d Benavd€s Jlan villegas SalTnaiero Ward 4 Ward 5 Ward 6 dbenavdes@sanla.ana.ord ivilleoas@san€-anaoro gEaierc@$!.la:@a,g!9