1201 S Douglas St - Misc. Permit

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licensed subcontractors and the number ol structures does not exceed four within any calendar years, or all ol the work is performed under contract with a licensed general building Contractor. 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 inancial or personal injuries sustained by any subsequent owne(s) that result from any latent construction delects in the workmanship or materials 9. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Se ce, the United States Small Business Administration, the California Department ol Benelit 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 for more inf ormation about licensed contractors. LI-LIO.l am aware ot and consenl to an Owner-Builder building permit applied for in my name, and understand that I am thb [arty legally and financially responsible for proposed construction activity at the following address: 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all app licable laws and requirements that govern Owner-Builders as well as employers inf o 2. I agree to notify the issuer of this rorm immediately of any additions, deletions, or changes to any of the ation 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 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 lor 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 responslble Ior verifying whether or not those Contractors are properly licensed and the status ol their workers' compensation insurance coverage. Betore 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. /Votei Aco DV of the DroDertv wncr' 1 drivcr's license- form notarization, or other veritication acceptable to aoencv is reouired to be presented when the permit is issued to verifv the property owner's signature./a' Signature of Property Owner Date Print name of Owner AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice lo Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply 1or, sign, and iile the documents 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 Agent 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 filled out the above information and certily its accuracy. Property Owner,s Signature Date:_ Print Name of Owner Note: A copy of the owner's driver's license, lorm notarlzation, or other verilication acceptable to lhe agency is required to be prcsented when the permit is issued lo verify lhe property ownet's signature. :,|i'y.ii:,a.:,irrrir.a.rrtr/i..omt!,i..;!....r.::,..,:.\a.:i:.,14:.,1 SANTA ANA CITY COUNCIL moulidordsanla ana oro Mrchele Man'nez Mayor Pro Ten. Ward 2 r!i$nl!ez@sa!la:a V cenle Sam enlo vsarm enro@sanra.ana oro E!lq!@sada:a!aq9 P Oavd Be.avides dbenavrdes@santa-ana oro ivrXeg-as@$da:ala stinaiero@sanla'ana.oro I ,,J Address ol Authorized Agent:_