10193423 - Permit (2) - Laserfiche WebLink

Home Browse Search

licensed subcontractors and the number of structures does not exceed four within any calendar years. or all ol the work is performed under contract with a licensed general building Contractor. V A. I understand as an Owner-Builder if I sell 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 lrom any latent conslruction delects in the workmanship or materials. -U-g. f 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 Calilornia Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. 10. I am aware ol and consent to an Owner-Builder building permit applied for in my name, and understand that I am the part gall and f inancially responsible for sed construction activi at the loll rnro addres I 11 I agree lhat. as the party legally and financially responsible lor this proposed construction activity, I will abide by allapplicable laws and requirements that govern Owner-Builders as well as employers. X t 2. I aoree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the inJ-ormation'i have provrded on this lorm. 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 ror 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 Conlactors, you will be responslble for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Belore 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. /Vote.' A coDv of the Dropertv ownet's driver's license, form notarization, ot othet verification acceptable to the aoencv is reouired to be presented when the Dermit is to the wner s nature. Signature of Property Owne Dale 7 ,20 1 Print name of Owner ,\lt hau +11\v\ l) o le,l\<\ec- AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice lo Property Owner, lhe execution ol which lunderstand is my personal responsibility, I hereby authorize the ,ollowing person(s) to act as my agent(s) to apply lor, sign. and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construclion Projecl (or Descriplion ol Work) Name ol Authorized Agent Address of Authorized Agenl Phone Number of Authorized Agent I declare under penalty of perjury lhat I am the property owner for lhe address listed above and I personally filled out the above information and certify its accuracy. Properly Owner's Signature Date Note: A copy ol the owner's driver's license, fom notarlzation, ot other verillcation acceptable to the agency is required to be prcsenled when the pemit is issued to verily the propeiy owner's signature. SANTA ANA CITY COUNCIL mo!hdolasanla-an: o.o Mayor P.o Tem. Wa,d 2 fltun'nez@snl..a.a.ord vsarm,e.ro@sanra.anaoro'sclono@sanra-anaoro dbenavLdes@sanra.a.aoro lrlegar@sadr:ala,q9 ) Project Location or Address:_ Print Name ol Owner: slrna..o(asnla-ana oro