10193419 - Permit - Laserfiche WebLink

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licensed subcontractors and the number o, structures does not exceed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. A6 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable lor any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction delects in the workmanship or materials. AA 9. I understand I may obtain more inlormation regarding my obligations as an "employer" Irom the lnternal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the Calilornia 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 inlormation about llcensed contractors. .A6 10. 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 financially responsible for proposed construction activity at the lollowing addrcss: zzTB 6-, u9-> r.J & 11.1 agree that, as the party legally and financially responsible for this proposed construclion activity, I will abide by all appllcable laws and requirements that govern Owner-Builders as well as employers. ^1'- 12.1 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 linancial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contraclors may be in civil court. lt is also important tor you to understand that if an unlicensed Contractor or employee of that individual or firm is inlured 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 verilying whether or not those Contractors are propedy licensed and the status of their workers' compensalion insurance coverage. Before a building permil can be issued, this form must be completed and signed by the property owner and relurned to the agency responsible for issuing the permit. /Volej A copv of the propertv owner's driver's license, form notarization, or other verificatio n acceotable to the aoencv is reauired to be sented when the Dermit is <A,.Jl-}+ a^JA.. Zt\. '\2-1a'.' Print na me of Owner MV<f, J @<,,-r 2.o.u,a. --z- AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner. lhe execution of which I understand is my personal responsibility. I hereby aulhorize the lolowing person(s) lo acl as my agent(s) lo apply 1or. sign. and lile the documenls 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 Agenl Address ol Authorized Agent Phone Number ol Aulhorized Agenl I declare under penalty of perjury lhat I am the property owner lor the address listed above and I personally filled out the above inlormalion and certify its accuracy. Property Owners Signalure Dale Prinl Name ol Owner Note: A copy ot the 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 ve ly the property ownet's signaturc. SANTA ANA CITY COUNCIL moulldo{asnla.ara o.o Mayo. Pro Tem, Ward 2 frrâ‚¬nrne2@sa.ra ana oo V'cenre Samleno v$h'enro@santa.ane.od E9lgr9@taqa:a!a.!r!to'lleas@snla.ana o.o $!rg@rsdq3!i.qg lssued to verifv the DroDertv owner's sionature. Signature of Property owne, AO Date: r t ,- I rz