2042 S Hickory St - Misc. Permit

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licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is performed,under contract with a licensed general building Contractor. {df- u I understand as an OwnerBuilder if I sell the property for which this permit is issued, I may be held liable for any financial.or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workmanshlp or materials. fl4L S. I understand I may obtain more information regarding my obligations as an "employea'f rom the lnternal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Divrsron ol lndustrial Accidents. I also understand I may contact the Calilornia Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. fJ{L ro. 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 Tll- f .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. ftlf. e. I agree to notify the issuer o, this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated 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 frnancial loss you may suslain as a result o{ a complaint. Your only remedy against unlicensed Contractors may be in civll court. lt ]s 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 for verifying whether or not those Contractors are properly licensed and the status ol their workers' compensation lnsurance coverage. Berore a building permit can be issued, this lorm musl be completed and signed by the property owner and returned to the agency responsible for issuing the permit. /Vote: A coov of the propertv owner's driver's license, lorm notarization, or other verification acceptable to the aoen v ,s redu to be Dresented when the oermit is issued to verifv the proDertv owner's siqnature. Signature of Property Owner +--J-{t-o^t", sl lu I zp I1 Print name of Owner ft.-ov.so'"^-- AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution ol which I understand is my personal responsibility, I hereby authorize lhe following person(s) to act as my agent(s) to apply for, sign, and lile the documents necessary to obtain an Owner-Builder Permil for my project. Scope of Construction Project (or Description of Work) Project Location or Address Address of Authorized Agent Phone Number of Authorized Agent I declare under penalty of perjury that I am the property owner lor the address lisled above and I personally tilled out the above information and certify its accuracy. Dale Print Name oi Owner Note: A copy ol the owner's driver's license, form notarization, or other verilication acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. , i, i,:. , .:.. \ i...rr.:, ., t .. . ,. .. SANTA ANA CITY COUNCIL mouIdo@sanla-ana.oro M.hele Maamez lrayor Pro Tem, Ward 2 mimarine2@sanra ana oro vsarmienro@santa.ana.oro sororo@sanraaraoro P. Dav'd Benavdes dbenav des@sanla.ana.oro ivil!eoas@santa'ana o.o sInaiero@santa-ana.oro -Gr-F.o-57^lcO Name ol Authonzed Agent: Properly Owners Signature: _