1708 S Center St - Misc. Permit - Laserfiche WebLink

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Mo 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the p arty legally and financiall y respo nsI ible for prop osed construction activ ity at the following address: l-Jn 3 1 c.^l s )" A.. cA ?>'7 M O 1,. I 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-Bullders as well as employers. WZ.I agree to notify the issuer of 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 financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. lt is aiso 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 Contaclors, 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 compl returned to the agency responsible for issuing the permit. Nofe.. eted and signed by the property owner and form notarization, or other verification able to the aoencv is ired to be Dresented w the permit is issued ao verifu the Dropertv own er's siqnature. Date: q )Signature of Property Owner I tq Print name of Owner 40" o n al(') r da L 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 thefollowing person(s) to act as my agent(s) to apply for, sign, and file the documenti necessary to obtain a; owner-Builder permit for myproject. Scope of Construction Project (or Description of Work) Name of Authorized Agent Address of Authorized Agent:_ Phone Number of Authorized Agent I declare under.penalty of perjury that I am the property owner for the address listed above and I personally fi ed out the aboveinformation and certify its accuracy. Property Owner's Signature Print Name of Owner: Date Note: A copy of the owne be presented when the pe r's driver's license, form notarization, or other verification acceptable to the agency is required to rmit is issued to verify the properly owner's signature- SANTA ANA CITY COUNCIL Mayor Pro Tenr Ward 2 mo!lido@santa-ana oro Vrce.te Sarm enlo vsarmienro@sanra anaord isolonorOsan16-ana.oro dbe.avldes@sanla ana ora iv eoas@sa.la ana oro siinaiero@santa-a.a.oro licensed subcontractors and the number of structures does not gxie#four within any calendar years, or all of the work isperformed under contract with a licensed general building Contractor. fiO-a I understand as an Owner-Builder 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 owner(s) that result from any latent construction defects in the workmanship or materials. Uqg I understand lmayobtaln more information regardang my obligations as an "employer" from the lnternal Revenue Service, 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. A copv of the Dropertv owner's driver's license, Project Location or Address: _