1247 E Fourteenth St - Misc. Permit

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licensed subcontractors and the number of structures does not excee.lJour \iithin any calendar years, or all of the work is performed under contract with a licensed general building Contractor. t /1 /\5u\ a. t understand as an Owner-Builder i{ I sell the property tor which tniJpermil is issued, I may be held liable tor any fin'ancial or personal injuries sustained by any subsequent owne(s) that resuli from any latent consiruction delects in the workmanship or materials. 9. I understand I may obtain more information regarding my obligations as an "employer" f rom the lnternal Revenue ervrce.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.oov for more inf ormation about licensed contractors. AA ,l0. I am aware of and consent to an Owner-Builder building permit applied lor in my name, and understand that I am the party legall address: and n anc ially re n le for OS nst ction ctlvl att e low o AQ r f. I agree that. as the party legally and financially responsible for this proposed construction activity, I will abide by alT applicable laws and requirements that govern Owner-Builders as well as employers. (.:t\tz. t 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 ol a complaint. Your only remedy against unlicensed Contractors 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 lor 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 lo the agency responsible lor issuing the permit. A/ote: A copv ot the propertv owner's driver's license, uired to be ted when the issued to ven the owner's Signature of Property Owner Date 5\1\\4 Print name of Owner 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 file the documenls necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description ol Work) Proieci Locat on or Address Narne oi Authorized Agent Address 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. Property Owner's Signature Date Print Name of Owner Note: A copy of the owner's d ver's license, form notarization, ot other verification acceptable to the agency is required to be presented when the permit is issued to verify the properly owner's signature., ': SANTA ANA C TY COUNCIL mo! do@santa ana oro Mayor Pro Tem. Ward 2 mrmartine2{asanta ana.oro V cenle Sarm ento vsarm ento@santa-ana.oro solor o(asanla ana.oro P. Davd Benav des !be!av.de!@ra!G:a N lreoas@sanla afa oro stira ero@sanla.ana.oro Phone Number ol Authonzed Agenl: