10196319 - 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. lA-g t understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any frnancial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or materials. ,ljC.-S I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Service, the United States Small Business Admin:stration, 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 information about licensed contractors. *{t f O. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address: U\-1,1 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. l,,lL rr. , 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 financlal 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' com pensation 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. A/ote : A coDv of the DroDertv ow ner's driver's I icense- form notarization. or other verification acceptable to t aqencv is reouired to be Dresented when the permit is rssued fo verifu the propefty owner's signature. Signature of Property Owner Date -9r , / zc,rf: Print name of Owner FCeJ S+c.u+a,*L 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 Project (or escription of Work) Project Location or Address Name of Authorized Agen Address of Authorized ent: Phone Number of A orized Agent ldeclare informati Property u nder alty of perjury that I am the property owner lly filled out the above on an rtify its accuracy r's Signature Print Na oi Owner: /Vofe;copy of the owner's driver's license, form 'ta rization, or other Yerification able to the agency is required to be sented when the permit is issued to yerify p ro pe rty ow ne r's s i g n atu re SANTA ANA CITY COUNCIL the address listed above and I pe Date: moul,do@sanla ana oro Mayo. Pro Tem, Ward 2 mlmadr.ez@santa ana.oro vsarmie.io@sa.ta-ana oro soloro@sanra-a.a.oro rv ecasOsa.la-ana oro stha ero@sanla ana.oro