20263604 - Permit (2) - Laserfiche WebLink

Home Browse Search

)=A-a. t understand as an Owner-Builder if I sell the property for which tllis 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. Ld-9. t understand I may obtain more information regarding my obligations as an "employer" from the lntemal 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 Califomia Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. ) 1\ tO 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 finaqcially respo!sible for propgsed gonstruc-lion activity at the following address: . ?).) t 1..t)t,c1,r r lh -!2t,, *t ll,\^ ?4 1)7c'4 ,1. A t t. 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. Jil'tZ.l 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 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' 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 perm it. /Vo,e. A copy of the propefty owner's driver's license, form notarization or other verification ac table to the ls to be ted when the ,s issued lo the s,nature, Signature of Property Print name of Owner Owner Date 0/2(/tz JoA v i\{r 4uio-t- AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution ol 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-Bullder Permit for my p.oject Scopo of Consfuction Pmject (or Description of Work) Project Location or Address: - 3))l 5' -0"r0t., !)<";L A r,o c4.j)l,y Clt"q qct4, d1l )aLr 1o,.,-]a 0u /-t 0Y, ril[;t Name of Authorized Agent Address of Authorized Agent:3 ) Lort e a,l '0C' Sqr/n- Ant tt|. ?+V'7 Phone Number ol Authorized Agent I declare under penalty of perjury that I am the properly owner for the address listed above and I personally filled out the above inlormation and certify its accuracy Property Owner's Srgnature Print Name of Owner: 1 o tr') vYr &u nt'L t/j( //7Dale )9!oO: a copy of tha ownefs drtvels licfise, fon nobizrtion, or other verlficstion acceptable to the agcncy is requlred ,o be prasented when the permft is lssued lo verlfy the goperty ownals slgnalure. Pirnk !',,'P5l CounlerAcriiv l), Ass.nrblyer s l'Jctr.. rc l.cpeiy Forn. t;-ir-:Ci5 SANTA ANA CITY COUNCIL MP!hdo(D$nl.-ana do Mey!. Pio Tâ‚¬m. Ward 1 !6.mdldAsnta-an. do tlM,nnâ‚¬zrOsrta-,ne ud 6AEeaou@ill&ilr,lrs OBenav'd6s6snta-anaor. RRefi. santa-anaoro S!-lrClgjOt4tijilill! '6c, rVl !t I a\ cl H{.