1440 S Broadway - Misc. Permit (2)

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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 p erformed under contract with a licensed general build ing Contractor L l understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any n n cial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the wor nship or materials 9. lunderstand lma y obtain more information regarding my obligations as an "employer" from the lnternal Revenue lce,the United States Small Business Adminastration, the California Department of Benefit Payments, and the California Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CS at 1 -800-321-CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am party legally and financially respo nsible for prop sed construction activity at the following 7 ?A7oladdress 1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by applicable laws and requirements that govern Owner-Builders as well as employers nform 2. I agree to notify the issuer of this form 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 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 for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Before 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 mit. Note.' 4 of ti form notarization or other verification when the it is issued to Signature of Property Owner Date Q> Print name of Owner W u <- 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 agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my proiect. Name of Authorized Aqent Address 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. Date Print Name of Owner: Note: A copy of the owner's driver's license, form 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. lrr .[ ri]Pa i .r |irr i\:r! rr'i::r,.: r11 .rii)r,{it,p..t.\:t..-,...,1.\a.a SANTA ANA CITY COUNCIL solo.o@sant6 ana oro P Oavid Benavdes dbenavrdes@sanla-.na.o.o ivilleoas6sanlaâ‚¬.a o.o sl'na e106sa.ta a.a oro ScopeofconStructionProject(orDescriptionofWork): Project Location or Address: Prope(y Owner's Signature: MrguolA Puido Mlchere Manrnez Vrcenre Sa.rnienloMayor Mayor Pro Tem, Ward 2 Ward 1 mou do@santa an6 oro m harlinez@sanla-ana oro vsarmrenio@sanla-ana.oro