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2130 S Forest Ave - Misc. Permit
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2130 S Forest Ave - Misc. Permit
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Last modified
7/6/2021 11:02:51 AM
Creation date
6/29/2021 8:07:13 AM
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Misc. Permit
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2130 S Forest Ave
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licensed subcontractors and the number of structures does not'exceeci four within any calendar years, or all of the work is <br />pe rf rmed under contract with a licensed general building Contractor <br />8. I understand as an Owner-Builder lf I sell the property for which this permit is issued, I may be held liable {or any <br />ncial or personal injuries sustained by any subsequenl owner(s) that result from any latent construction defects in the <br />workmanshi p or materials <br />9. lunderstand lma y obtain more information regarding my obligations as an "employef'from the lnternal Revenue <br />ice, t he United States Small Business Administration, the California Department ol Benefit Payments, and the <br />a lifornia Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board <br />C LB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors <br />th pa <br />10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am <br />rty legally and financially responsible for proposed construction activity at the following <br />dd ESS <br />11. I agree that, as the party legally and linancially responsible for this proposed construction activity, I will abide by <br />plicable laws and requirements that govern Owner-Builders as well as employers <br />12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the <br />rmation <br />Licensed contractors are regulated by laws designed to protect the public. lf you contract with someone who does not <br />have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain <br />as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. lt is also important for <br />you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your <br />property, you may be held liable for damages. lf you obtain a permit as Owner-Builder and wish to hire Contactors, you will <br />be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' <br />compensation insurance coverage. <br />torm notariza <br />wn <br />Signature of Property Owner Date <br />Scope ol Construction Project (or Description of Work) <br />Project Location or Address +h't<-.*a.-6a\ <br />Name ol Aulhorized Agent <br />Address of Authorized Agent 5.Fla \a 1zlocl <br />Phone Number of Authorized Agent q <br />I declare under penalty of perjury <br />information and ce(ify its accurac <br />atlamth rope ner for the address listed above and I personally lled out the above <br />Property Owner's Signature Date e \o <br />Print Name oi Owner: <br />Note: A copy ol the owner's driver's license, torm no tion,oro verification acceptable to the agency is required to <br />be presented when the permit is issued to verity the property owner's signature. <br />SANTA ANA CITY COUNC]L <br />moulido@sanla-ana or. <br />lMayor Pro Tem. Ward 2 <br />m ma'1rner@santa.ana.oro <br />v cenle sarmienro <br />vsarmrenlo@sanla.ana.oro i$Ls!r.a@sa@:e!a ivilleoas@santa a.a.oro sr naie.o@sanla.ara.oro <br />I have provided on this Iorm. <br />Before a building permit can be issued, this lorm musl be completed and signed by the property owner and <br />returned to the agency responsible lor issuing the permit. Nofej A copv ot the prcpertv owner's driver's license. <br />Print name of Owner <br />AUTHORIZATION OF AGENT TO ACT ON PBOPERTY OWNER'S BEHALF <br />Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the <br />,ollowing person(s) to act as my agenl(s) to apply tor, sign, and iile the documents necessary to obtain an Owner Builder Permil for my <br />project. <br />I Jz+o1 <br />I <br />P. Dav'd Benavrdes <br />dbenavides@sarta-ana oro
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