1515 W Eleventh 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 rmed under contract with a licensed general building Cortractor 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any ancial or personal injuries sustained by any subsequent owne(s) that result lrom any latent construclion detects in the manship or materials 9. I understand I may obtain more lnformation regarding my obligations as an "employef'from the lnternal Revenue rvice, the United States Small Business Administration, the California Department ol Benefit Payments, and the lilornia Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at '1-800-32'1-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors '10. I am aware of and consenl to an Owner-Builder building permit applied tor in my name, and understand that I am the party address: legally a nd financially responsible lor proposed construction activity at the followingt/S tat €._e ve 4tt' J.r , _1 1. I agree that, as the party legally and financially responsible for this proposed construclion activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. _12. I agree to notify the issuer of this Iorm immediately ol any additions, deletions, or changes to any of the inlormation I have provided on this lorm. Licensed conlraclors are regulated by laws designed to protecl the public. lf you contract with someone who does not have a license, lhe Conlractors' State License Board may be unable to assist you with any linancial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. lt is also impo(anl for you to understand that if an unlicensed Contractor or employee of that individual or lirm is injured while working on your property, you may be held liable for damages. ll you obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible Ior 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, th lorm must be completed and signed by the property owner and ng the permit. Note: A copv of the Dropertv owner's driver's license.returned to the agency responsible f form notarizati or other verif ica table to the ,s uired to be to o nature. Signature of Property Date:.f.Ja rf Print name of Owner tu)O F*tucldaz AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice lo Properly Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply tor, sign, and iile the documents necessary to obtain an Owner Builder Permit for my project. Scope of Construction Project (or Description of Work) Proiect Location or Address 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 filled out the above information and certify its accuracy. Dale Print Name of Owner Note: A copy ol the owner's driver's license,lorm notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the prcpefty owner's signature.).fLr\,ir:lr,r:.rr,:r:A.-!tfr.i,;.:r;,ir::jr.r,.it:ri.r,.t!ir::[,::1,,:]i SANTA ANA CITY COUNCIL mouldo@sanla ana.oro [,] chele [ra.linez Mayor Pro Tem, ward 2 mlmarl nez@sanla.ana.oro Vicenle Sa.mrenro vsarmienlo@santa-ana.or.isoloro@sanla.ana.oro dbenavrdes@sarta.anaoro prlleoas@sanleana.oro slrraiero@sanla-anaoro Name ol Authorized Agent: _ Property Owner's Signature: