20166675 - 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 ormed 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 financial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or materials. M 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 rvww.cslb.ca.oov for more information about Iicensed contractors. k o I am aware of and consent to an Owner-Builaer building permit applied for in my name, and understand that I am the party legally and finFnciglly responsible for proposed construction activity at the followingaddress: / 14 ld /T?r n a re l- f) . . .lWr't I agree that, as the party legally and financially responsible for this proposed construction activity, I wall abide by4ll applicable laws and requirements that govern Owner-Builders as well as employers. M,r. ragree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the iffirmat;onl 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. 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 pe rmit. /Vote: A copy of the property owner's driver's license, form ired to be ted when the it is issued to veri the ow nature. Signature of Property Owner Date Print name of Owner Lu /^,. AUTHORIZATION OF AGENT TO ACT ON PROPERry 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. Scope of Construction Project (or Description of Work) Project Location or Address Name of Authorized Agent: Address of Authorized Agent; Phone Number ofAuthorized 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 lhe owner's driver's license, form notarization, ot other yerilication acceptable lo the agency is required to be presented when the permit is issued to verify the property owner's signature. P i! ii:: !..r"--ai_,,., ir:i".,,i i^i]:..i.l'.r:inrI-_. aII:1:.-. SANTA ANA CITY COUNCIL mou ao@sa.ra-ana oro M.yor P.o Tem Ward 2 h man nez@sanla a,rE.oro vsam ento1osanla-ana.o.o Eolono@santa-ana oro dbenavides@santaâ‚¬na oro vrlleoas@sanla-ana oro strnaâ‚¬rc@santa-ana oro