1100 W Warner Ave - Misc. Permit

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licensed subcontractors and lhe 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 Conkactor. \/4 _K_A. t understand as an Owner-Buitder if I sell the property for which this permit is issued, I may be held liable for any ffla\Ctal or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the 'forkmanship or materials. 7-9. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue //nlice, tfre United States Small Business Administration, the California Department of Benefit Payments, and the,datiiornia Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board CSLB ) at 1-800-321-CSIB (2752\ or www.cslb.ca.oov for more information about licensed contractors 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am rty legally and fi nanciallv resoons r^1 "liqdea ible for orooosed construction activitv at the followinoA'lts.' 5rl+ri{ /+ra ZA zazky d ress llDZ) 1'l. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by app licable laws and requirements that govern Owner-Builders as well as employers 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the ormation 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 Contraclors may be in civil court. lt is 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 Owner-Builder and wish to hire Contactors, 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 completed and signed by the property owner and returned to the agency responsible for issuing the permit. /Vote.'the owner's driver' form notarization, or other tion acceDtable to the aaencv is required to be ted when the Dermit is issued to veri the ro Signature of Property Owner Date: 4,- {' tA Print name of Owner t "v5n 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 the following person(s) to act as my agent(s) to apply for, sign, and flle the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Prolect (Description of Work) Project Location or Address Name of Authorized Age Address of Authorize ent: Phone Number of orized Agent ldeclare informati Property under enalty of perjury that I am ally filled out the above ona certify its accuracy r's Signature Print e of Owner A copy of the owner's dri s license, form not tion, or other verifica acceptable to the agency is required to be presented when ,he perm it issued lo verify the owner's signature Pi.rnk:VJP51/Counie.Aclrv yiAsse.rblyB llslN ro Propeny f.ro c3-1.-2016 SANTA ANA CITY COUNCIL property owner for the D listed above and I peress mou do@sanla-ana oro Micheie Man nez Mayor Pro Te.n Ward 2 rn marti.ez@sanla-ana.oro Vicenre Sarmlenlo vsarh enro@sa.1a-a.a.oro so ono@sanla ana oro P Oavid Be.avides db€navrdes@sanla En6oro v eoas@santa-ana oro stinarero@sanla-ana.o.o