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1418 N Mar Les Dr - Misc. Permit
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1418 N Mar Les Dr - Misc. Permit
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Last modified
7/27/2021 11:22:31 AM
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7/27/2021 11:22:18 AM
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Misc. Permit
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1418 N Mar Les Dr
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l--D-r. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Ser- <br />vice, the United States Small Business Administration, the C?lif-ornia Department of Benefit Payments, and the California Divi- <br />sion of lndustrial Accidents. I also understand I may contact the Caiifornia Contractors' State License Board (CSLB) at 1-800- <br />, 321-CSLB (2752) or www.cslb.ca.qov for more information about licensed conkactors. <br />' I t/ tO I am aware ofand consent to an Owner-Builder building permit applied for in my name, and understand that I am the <br />51"?r9",{fffl lT\"nvt{I "ooo{o ff <br />n"u?n''H acti,t}fr59frlouns ad- <br />\ .- .. --_ <br />trLl t. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all <br />applicable laws and requirements that govern Owner-Builders as well as employers. <br />T2,r.l agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I <br />have provided on this form <br />Licensed contractors are regulated by laws designed to protect the public. lf you contract with someone who does not have a <br />license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of <br />a complaint. Your only remedy against unlicensed Contractors may be in civil court. lt is also important for you to understand <br />that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held <br />liable for damages. lf you obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible for verifying <br />whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. <br />Before a building permit can be issued, this form must be completed and signed by the property owner and returned <br />to the agency responsible for issuing the permit. ,Vofe; A copv of the propertv owner's driver's license, form notariza- <br />tion, or other verification acceptable to the aoencv is reouired to be Dresented when the permit is issued to verifv the <br />plopefty owner's siqnature. <br />Signature of Property Owne v1) <br />Print name of Owner c D\/\ <br />AUTHORIZATION OF AGENT TO ACT ON PROPERry OWNER'S BEHALF <br />Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize <br />the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder <br />Permit for my project. <br />Project Location or Address <br />Dale: \ \ <br />Name of Authorized Agent <br />Address of Authorized Agent: <br />Phone Number of Authorized Agent <br />I declare under penalty of perJury that I am the property owner for the address listed above and I personally filled out the above <br />information and certify its accuracy. <br />Property Owner's Signature <br />Print Name of Owner: <br />ScopeofConstruCtionProject(orDescriptionofWork): <br />noto'_ <br />Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is re- <br />quired to be prcsented when frre perrrrr? is issued to verffy the property owner's signature.
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