305 N Figueroa St - Misc. Permit

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licensed subcontractors and the number of slructures does not exceed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. ,' i c trfl L a. t understand as an OwnerBuilder if I sell the property for which this permit is issued, I may be held liable tor any 'linancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction delects in the workmanship or materials. t.,l"t( g. I understand I may obtarn more information regarding my obligations as an "employef'from the lnternal Revenue Service, the United States Small Business Administration, the Calilornia 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.oov for more information about licensed contractors. /l(- lO.l am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legall address: y and f inancially res nsible lor pro d truc on activ at the f ollowin s l,'L ,l.l agree that. as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. /ll e.l agree to notify the issuer of this lorm immediately ol any additions, deletions, or changes to any ol the ihfoFmation I have provided on lhis lorm. Licensed contractors are regulated by laws designed to prolecl the public. ll 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 ol a complaint. Your only remedy against unllcensed 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 OwnerBuilder and wish to hire Contactors, you will be responsible lor verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Belore a building permit can be issued, this form musl be completed and signed by the property owner and returned to the agency responsible for issuing the permit. /Vote,' A coDv of the Dropertv owner's driver's license, torm notarization. or other verilication acceDtable to the aoen c v ,s reou ired to be Dresented when the Dermit is Signature ol Property Owner Print name of Owner Date:20 2.o / mt"l Lq h 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 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 proiect. Scope of Construction Project (or Description of Work) Name of Authorized Agent Address of Authorized Agent I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled oul the above information and certify its accuracy. Property Owner's Signature Date Print Name of Owner: Note: A copy ot the owner's driver's license, lom nota zation, or other veritication acceptable to the agency is required to be presented when the pemit is issued to verily the prope,ly owner's signature. SANTA ANA CITY COUNCIL mour do@sanla-a.a.oro Mayor Pro Tem, Ward 2 m man ne2@sanla-ana.ord Vr.erre Sarmienlo vsarm enlo@sanla-ana.oro Boloro@sanla'ana oro dbenav des.asafla ana oro iv lleoas@santa'ana oro $D3iei!@la!la:a!3.qc Project Localion or Address; Phone Number of Authorized Agent: