2624 N Towner St - Misc. Permit - Laserfiche WebLink

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lonfr t1lrcensed subcontractors and the number of structures does not exceed four within any calendat years, or all of the work isperformed under contract wrth a licensed general building Contraclor. ./ 8 l understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for anyfinancial or personal iniuries sustained by any subsequent ow;e(s) that resuli from any lateni conitruction defects in thelvorkmanship or materials. --',1-9 I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Seruice, the United States Small Business Administration, tnebaiifornii Departmenl of Benefit payments, and the Caltfornia 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 contracrors. J 10. 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 financially responsible.for proposed construction activity at the following address: 2624 N. Towner St. Santa Ana CA. 92706 t/ 11.1agree that, as the party legallyand llnancially responsible for this proposed construction activity, lwill abide by all applicable laws and requirements that govern Owner-Builders as well as employers. y' 12. I agree to notify the issuer of this form immediately of any additlons, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws desagned 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 courl. lt is aiso important for you to understand that if an unlicensed Conlractor 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 Contaclors,-you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their wo.kers' 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.. form no tarization, or other verification table to the aaencv rs to be ore sented when the Definit is issued fo VD the ow 'ss n Signature of Property Owner Date: 01/04/2019 Print name of Owner Loan Crawford AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I undersiand is my personal responsibility, I hereby aulhorize the lollowing person(s) to act as my agent(s) to apply tor. sign, and tile the documenti necessary to obtain ah Owner-i!uilder permit for myproject Scope of Constructioo Project (or Description oF Work)Remove and reolace existino roof at house and qaraqe ProJ cct Location or Address: 2624 N. Towner St. Santa Ana CA. 92706 Name of Authorized Agen t: Mike Zadeh Address of Authorized Ag ent 1415 E 17th. St. # 270 Santa Ana CA. 92705 I dcclare under penalty of perjury thal I am the property own r for the address listed above and I personally filled out the above rnformation and certify ils accuracy Prope(y Owner's Signalure Print Name of Owner: Loan Crawford Nole: A copy of th e owner's driver's license, form notarization, or othet veification acceptable to the agency is required to be presented when the permit is issued to verify lhe ptope,ly owner's signature. SANTA ANA CITY COI,JNCIL May.r ft6 Ten W6rd 2 lrr,rocsFia:ana_ql v.5re samenro r.rrmr.rloosait. an..l9 tro:919t&s!!!:!r!-!!q -: era!i.?s6A copv of the Drooeftv owner's driver's license, Phone Number of Authorized Agent: 714 541-8011 Date: 0110412019