1017 N Logan St - Misc. Permit - Laserfiche WebLink

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licensed subcontractors and the number ol structures does not exceeci four w,ihin any calendar years, or all of the work is pgrformed under contract with a licensed qeneral buildinq Contractor. '. -_)4. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any' finanbial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. - .'19. I understand I mav obtain more information regarding my obligations as an "employea'from the lnternal Revenue $ffirhe United States Small Business Administratio,-n, thebalifornii Department of denefit Payments, and the California Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or w$ryv.cslb.ca.qov for more information about licensed contractors.4io GJGlvt I am aware of and consent to an Owner-Builder building permit applied lor in my name, and understand that I am egally an d financiall y resp onsible for propo sed constru on activity at the followi ng address:o L 6 ./)o/ "_J911. I agree that, as the party legally and f inancially responsible for this proposed construction activity, I will abide by al{ applicable laws and requirements that govern Owner-Builders as well as employers. ' ' , f2. I agree to notity the issuer of this form immediately of any additions, deletions, or changes to any of the ' inlormation I have provided on this Iorm. 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 Ior verilying 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. Note.'Aco DV oft he DroDertv wncr's driver's -se- rm the ,s uired to be ted when the issued to veri the Signature of Property Print name of Owner Own Date:2),/ <-I ?/A /Z- AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agenl(s) to apply 1or, sign, and file the documents necessary to obtain an Owner-Builder Permil for my project. Scope ot Construction Project (or Description of Work) Prolect Location or Address Name of Authorized Aoent Address of Authorized Aqent Phone Number of Authorized Agent I declare under penalty of perjury that I am the property owner for the address listed above and I personally lilled out the above information and certify its accuracy. Date Print Name of Owner Note: A copy ol the owner's driver's license, lotm notarization, or other veritication acceptable to the agency is rcquired lo be presented when the permit is issued to verily the property owner's signature. ::, r.! \.irtri -r.. r ir A. . i r'i.r.I irt,,i) r f .! i..,, :: -,rr. r - r.... -. :i- -, SANTA ANA C TY COUNCIL hoL do@sanla-ana.oro Mayor Pro Tem. Ward 2 mrmanr.ez@saf ta-a.a.oro V cenle Sarm enlo $49 j.!e!&@$ga:a!a.qq ls9lsl!@!3!la:a!a.!I!dbenav,des@sa.1a'anao.c iyiX9!as@sa&:a sl nalero@sanla-ana o.o --24 Property Owneas Signature: _