10196386 - Permit - Laserfiche WebLink

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licensed subcontractors and the number of structures does not exceed four within any calendar years, or al] of the work is performed under contract with a licensed general building Contraqtor. Ax(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 financial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or materials. -1 Ln I understand I may obtain more information regarding 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. qnL_10. I am aware of and consent to an Owner-Builder building permit applied for in my namei and understand that I am the party I lly and financially (esponsible for proposed construction activi att he following address ^,/E 3tuqn 70 Q.n--11. 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-Builders as well as employers Prrt-12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the lnformation 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 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. Signature of Property Owner Date Print name ol Ownet ,.1 ?rrre.O m;E-- 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 documents necessary to obtain an Owner-Builder Permit for my prgect. Scope of Construction Project (or Description of Work) Project Location or Address Name of 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 lilled out the above information and certify its accuracy. Property Owner's Signature Date Print Name of Owner: Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be prcsented when the permil is issued lo verify the prope y owner's signature. , ..;1,;]. 'j.-ir''A^] ,l] q::]ri',i] !'\]'..i:i,]i]1..); .-.-: ,l:..,.: SANTA ANA CITY COUNCIL moulido(osanla ana oro Mayor Pro Tem, Ward 2 mimart nez@sa.ta aoa oro vice.te Samiento vsamrenro@santa anaoro so o.io(osanla-ana oro P. Oavd Benavdes dbenavides@santa-ana o,o N eo6s@sa.l.-ana oro slinaiero@sanla-ana.oro 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. ivote.' A copv of the properu owner's driver's license, form notarization, or other verification acceptable to the aoencv is reduired to be presented when the permit is issued to verifu the DroDertv owner's siqnature. _, t-//- /g Phone Number ofAuthorized Agent: _