10291458 - Permit (2) - Laserfiche WebLink

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licensed subcontractors and the number of structures does nol exceed four within any calendar years, or all ol the work ls perfo16red under contracl with a Iicensed general building Contractor. 0&o. f undersland as an Owner-Builder il I sell the property lor which this permit is issued, I may be held liable {or any firiincial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or materials. M4. I understand I may obtain more inlormation regarding my obligations as an "employer" from the lnternal Revenue Service, the United Slates Small Business Administration, the California Department of Benefil Payments, and the Calilornia Division of lndustrial Accidents. I also understand I may conlact the Calilornia Conlractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more inlormation about licensed contractors. 'Yi l"-10. I am aware ol and consent to an Owner-Builder building permit applied for in my name, and undersland that I am the party legally and financially responsible Ior proposed construction activity at the following ..1.1/ac c' -0t1,1. I agree lhat, as the party legally and flnancially responsible lor this proposed construclion activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. $Vr r. I agree to notify the issuer ol this form immediately of any additions, deletions, or changes to any of the inlormation I have provided on this form. Licensed contractors are regulaled 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 Conlractors may be in civil court. lt is also important for you to understand that if an unlicensed Contraclor 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 lor 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. ,{ote.' A copv of the propertv owner's driver's license. lorm notarization, or other verification acceptable to t aoencv is reouired to be Dresented when the permit is ro ss nature. Dale (tSignature of Property Own Print name ot owner ffli P-t ; (iurS AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I undersland is my personal responsibility, Ihereby authorize the following person(s) to act as my agent(s) to apply tor. sign. and file the documents necessary to obtain an Owner-Builder Permit for my project. Scope o, Construclion Projecl (or Description ol Work) Proiect Location or Address Name ol Authorized Agent Address ol Authorized Aoent Phone Number ol Authorized Agenl: I declare under penalty of perjury that lam lhe property owner for the address listed above and I personally filled out the above inlormalion and certify its accuracy. Date Print Name ol Owner Note: A copy ot the owner's drlver's license, lorm notarization, or olher verilication acceptable to the agency is rcquired to be presented when the permit is issued to verily the prcperty owner's signature. SANTA ANA CITY COUNCIL moul6o@santa..na oro Mayor P.o Ten. Ward 2 h ma.t nez@enta-ana.oro v'6râ‚¬ Sarnento $s!rq!!&@la!la.aDr.s9 Eolono@sanla.anaoro &!!a!r!e5@Sa!l33!a Mllooas@santa-ana oro $oeie@@!a!ra:@a.sq Properly Owner's Signalure: