1112 N Louise St - Misc. Permit - Laserfiche WebLink

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licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. 4t U , understand as an Owner-Builder if I sell the property ror which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owne(s) that resull from any latent construction defects in the workmanship or materials. :(\-S. , understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Service, the United States Small Business Administration, the Calilornia Department of Benelil 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 www.cslb.ca.oov Ior more inlormation about licensed contractors. $a ,0. 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 Iinancially responsible for proposed construction activity at the followingaddress: t Z ^). Lov.tE <f. A t t I agree that, as the pady legally and financially responsible for this proposed conslruction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. fu,2. t agree 10 notify the issuer of this form immediately of any additions, deletions, or changes lo any of the infoimation I have provided on this f orm. Licensed contractors are regulated by laws designed to protect the public. lf you contract wilh 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. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while worklng 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' compensation insurance coverage. Belore a building permit can be issued, this lorm must be completed and signed by the property owner and returned to the agency responsible for issuing the per mit. Note.' A copv of the property owner's driver's license, torm notarization, or other verilication acceptable to the aqency is required to be presented when ttE_pelmnb issued to verifv the DroDertv owner's sionature. Signature ol Prope(y Owner Date: f Print name o{ owner 't;it t<, tt** /Yt',\L. --_--_ AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notlce 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 oblain an Owner'Builder Permit ior my project. SCopeofConstrUCtionProjecl(orDeScr]ptionolwolk):Z Project Location or Address Name of Authorized Agent Address of Authorized Agent I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above information and certily its accu *Property Owneas Signature Dale Print Name of Owner Note: A copy of the owner's driver's license, torm notarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. SANTA ANA CITY COUNCIL m.ul do@sanla.a.a oro rviayor Pro lem, Ward 2 mrmarlrnez@sanra anaoro v cente sarmiento vsarm enlo@santa-ana oro 60loro@sanla-ana oro P Dav d Benavides dbenavdos@sanra ana.oro lvi!!99as@!a&:a!@ sl narero@safta.ana orc Phone Number of Authorized Agent;