1209 E Park Ln - Misc. Permit - Laserfiche WebLink

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licensed subcontractors and the number of structures doe's not "r"""a four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. 5-li A. t understand as an OwnerBuilder rf I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defecls in the workmanship or materials. $ 4 t. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Bevenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division ol 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 licensed contractors. /,1a!!!lO I am aware of and consen't to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and flnancially r6spopsible for groposedponstrucJion activ addiess: - l.\Oq < flci I/ tr.o S,:,,r,\s 4a"., (*' ct)!.{h" totto*ins e4 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. JIAI2. I agree to notify the issuer of this lorm immediately ol any additions, deletions, or changes to any of the inlormation 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 for you to understand that il 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 for verilying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before a building permil can be issued, this lorm must be completed and signed by the property owner and returned to the agency responsible lor issuing the permit. Note; A copv of the DroDertv owner's driver's license. form notarization, or othet veritication acceptable to the agency is required to be presented when the permit is issued the wner s nature, 5.30',Joi'lSignature of Property Print name of Owner 5 Owner Date: e AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution ol which I understand is my personal responsibility, I hereby aulhorize the following person(s) lo 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 ol Work) Project Location or Address Name of Authorized Agent Address of Authorized Agent Phone Number of Authorized Agent ldeclare under penalty of perjury lhat I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Property Owner's Signature Date Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is required to le presen.ted ,wh:n the leyit is i?sued to verify the property owner's signature. SANTA ANA CIIY COUNCIL mpuldo@santa-ana.oro [rayor Pro Tem, Ward 2 mlmanrne2@sanra ana.oro vsamento@santa ana.oro solono@sa.la ana oro P Davd Benavdes dbenavrdes@sanla.ana.oro ivilleoas@sanra.a.a on slBier9@t344:a!a.qq ?"'Y Print Name of Owner: