1217 S Linda Way - Misc. Permit - Laserfiche WebLink

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licensed subcontractors and the number of structures does not exieed four within any calendar years, or all of the work is performed under contract with a licensed general buildlng Contractur. 8. I understand as an Owner-Builder if lsell the property for which thls permit is issued, I may be held liable for any n ncial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or materials. t#g I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue g6d/ice, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of 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.qov for more information about licensed contractors , Ial t0 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-finaqcially rqsponsible {or prgposed qonstruction activity at the following adoress: /?[-l s Itv.vlt l,L{\\]/ \/rtt./(lthtli fA.q1'7OL/'r-----/tVZ-7 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by al app licable laws and requirements that govern Owner-Builders as weil as employers *1 7 , J \ 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes lo any of the -rni#mation I have provided on this form. Licensed contractors are reguiated 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 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 responsible 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 the agency responsible for issuing the permit. /Vote : A copv of the DroDertv owner's driver's license. form notarization or other verifica ,s uired to be ented when the it is issued to the w Signature of Property Owner Date Print name of Owner AUTHORIZATION OF AGENT TO ACT ON PROPERry OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s)to act 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 Description of Work) Project Location or Address Name of Authorized Agent: Address of Authorized Aoent: Pl'one Number of Authorized Agent: Prlnt Name of Owner: Note: A copy of the owner's driver's license, form nolarization, or other verification acceptable to the agency is required to be presented when the permit is issued lo verify the propedy owner's signature, SANTA ANA CITY COUNCIL moul do@sanla-ana oro M.here Madrnez Mayor Pro Tem, Ward 2 m madrne:@sanla-a.a oro vsamre.roosa.la-a.a oro so orio@sanla-a.a.oro dbe.avrdes@sanla-ana.oro ville.asosanl6anaoro sl'.ae.oasa.raanaoro I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Property Owneas Signature: Date:_