20153662 - Permit (2) - Laserfiche WebLink

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//4L, I understand as an owner-Builder if I sell the property for which this permit is issued, I may be hetd liabte for any / / finahcial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. ervice, I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue 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 0. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am he arty legally and financially responsible for proposed construction activit y at the following addrcss:7ooq i^.C^hA,- 91. <.^t.?27 ,4 //Z', I agree that, as the party legally and financially responsible for this proposed construction activity, twiu abide by' all applicable laws and requrrements that govern Owner-Builders as well as employers. H4t, I 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. Llcensed 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 af 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 permit. ,Voter form notarization, or other verification accep table to the agency is required to be Dresented when the permit is issued to verifu the ertv owner's sionature Signature of Property Print name of Owner Owner Date 4-tq-L AUTHORIZ.ATION OF AGENT TO ACT ON PROPERW OWNER'S BEHALF Excluding the Notice to Property O\,vner, 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 of Authorized Agent I declare under penalty of periury 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 driver's license, form notarization, or other vedfication acceplable to the agency is required to be presented when the Wrmit is issued to verify the propefty owner's signalure. PLink:WP51/Counter Activrty/Assembly Bills/Notrce to Property Form 03-i3-2014 SANTA ANA CITY COUNCIL Mevry A!-16 W3.4 6 ST'.asolasanlz a6a m A^q6r,o &e/o,a , P O6\.n Baaudâ‚¬s iwiftl , wdil Ar@oaAsara'rE m i pâ‚¬sBhdâ‚¬.6sl3{rE m i RRe!.aAsa^ra a.a c.. l A coDv of the DroDeftv owner's driver's license,