101100221 - Misc. Permit - Laserfiche WebLink

Home Browse Search

licens subcontractors and the number of structures does not exoeed^four within any calendar years, or all ot the work is perfo ed under contract with a licensed general building Contractor I understand as an Owner-Builder il I sell the property for which this permit is issued, I may be held liable for any lor personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the anship or materials 9. I understand I may obtain more inlormation regarding my obligations as an "employer" f rom the lnternal Revenue ice, the United States Small Business Administration, the California Department of Benefit Payments, and the lfo ia Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board S at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am legally nciall spo n ble fo ro sed struction activity at the Iollowing re . I agree that, as the party legally and financially responsible ror this proposed conslruction activity, I will abide by icable laws and requirements that govern Owner-Builders as well as employers gree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the mation I have provided on this lorm censed contractors are regulated by laws designed to protect the public. lf you contracl 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 for you to understand that if an unlicensed Contractor or employee o{ 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 responsible for verifying whether or not those Contractors are properly Iicensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, this form must be completed and signed by lhe property owner and returned to the agency responsible for issuing no or other verificati issued to the owner's Signature of Property Print name ol Owner Owner Date ,zt--,-</-t2 AUT RIZATION 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 authorize the Iollowing person(s) to act as my agent(s) to apply for, sign, and Iile the documents necessary to obtain an Owner-Builder Permit for my project. Scope ol Construclion Projecl (or Description of Work):_ Project Location or Address Name of Authorized Agent Phone Number of Authorized Agent ldeclare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above inrormation and certify its accuracy. Prope(y Owner's Siqnature Date Print Name ot Owner Note: A copy ol 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 natu tl2Z- moul do@sanla'ana oro Mayor Pro Tem Waid 2 m madrnez@santa.ana.oro V'.enrc S.rm'enr. !ra!o!e!l!@ la:alr,alg isdlria@sa!.la:ala P Davd Benavides dbenav des@sanla-ana.o..ivilleoas@santa-ana oro qr.!aie!!@sa!.la:!!!.9a Note: A copv ot the propertv owner's driver's license, Address of Aulhorized Agent:_