20265957 - Permit - Laserfiche WebLink

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licensed subconkactors 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 Contractor 8. I understand as an Owner-Builder if lsell the property for which this permit is issued, I may be held liable for any cial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the anship or materials 9. I understand I may obtain more information regarding my obligations as an "employer, from the lnternal Revenue e, the United States Small Business Administration, the California Department of Benefit Payments, and thetc ifornia Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CS ) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors 0. 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 cially responsible for proposed construction a ctivi ty at the followinn 1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by plicable 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 ation 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 OwnerBuilder 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. form notarization or other verification ted when the ermit is issued fo the o nature. Signature of Property Owner Date 9-24-rf a I Scope of Construction Project (or Description of Work):_ 1/ Project Location or Address 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 documents necessary to obtain an Owner-Builder Permit for my project. Name of Authorized Agent 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 fllled out the above information and certify its accuracy. Property Owner's Signature Date Mayor Pro Tem. Ward 2 mi0aninez@santa ana oro V cenre Sa.mienlo vsamenro@sanla-a.3 orq isorono@sa.ta-ana oro P. Oaed Benavrdes dbenav des@sanla-ana oro ivleoas@sanla-ana oro str.alero@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. Note: A copv of the propertv owner's driver's license, Print Name of Owrrer: Nole: A copy of lhe owner's driver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. SANTA ANA C T/ COU\LIL moul'dor@santa a.a.oro