319 S Birch St - Misc. Permit - Laserfiche WebLink

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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. --1l,t!-a I understand as an Owner-Builder if I sell the propbrty 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. [tr-4-tn. tunderstand I may obtain more information regarding my obligations as an "employe/ from the lnternal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial 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 conlractors. [9 tl'lO.I am aware ot and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and fina address: lyr n slb for p constructi ctivity at the f ollowing (s{i1. I agree that, as the party legally and financially responsible lor this proposed construction activity, I will abide by all applicable laws and requirements that govern OwnerBuilders as well as employers. /l fi-( p t agree to notlly the issuer of thls 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 also lmportant for you to understand that il an unlicensed Contractor or employee of that individual or firm ls 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 Contactors, you will be responsible for veri{ying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permit can be issued, lhis lorm mus completed and signed by the property owner and returned to the agency responsible lor issuing the l. Note: A copv of the propertv owner's driver's license, form notarization ot other verificatio table is uired to be d when the it is issued to veri the o Signature of Property Owner Date 6 2 Print name of Owner o14 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 responsibillty, I hereby authorize the lollowing person(s) to act as my agent(s) to apply Jor, sign, and lile the documents necessary to obtain an Owner-Bullder Permit for my project. Prolect Location or Address Address of Authorized Agent Phone Number of Authorized Aoent I declare under penalty of perjury that I am the property owner lor the address listed above and I personally filled out the above information and certify its accuracy. Property Owner's Signature Dale Pr nt Name of Owner Note: A copy ol the owner's driver's license,lorm notarization, or other verilication acceptable to the agency is required to be presented when the permit is issued to verify the property ownet's signaturc- SANTA ANA CITY COUNCIL nature- h.ul'do@sa.la-ana.oro Mayor P.o Tem Ward 2 m marl ne2@sa ra ana.oro V ce6te Sam enlo $a!ErE!&@safla:a!a isolor o@sanra-ana oro P Davd Beoavdes dberavides@sanra.a.a oro rr.eoas@sa-ld d " o'o "0, drc oras"ild.dr a o' Scope of Construction Projecl (o. Desc.iptron ol Wo.k): Name of Authonzed Agent:_