1615 S Birch St - Misc. Permit - Laserfiche WebLink

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licensed subcontractors and the number of structures does not exceed Iour within any calendar years, or all of the work is perf m ed under contract with a licensed general building Contractor I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any 1i ncial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the m ship or materials o I understand I may obtain more information regarding my obligations as an "employea'from the lnternal Bevenue ice, the United States Small Business Administration, 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 B) at 'l -800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors 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 n sibl .â‚¬+p roposed construction activity at the followin s dr 1. I agree that, as the party legally and linancially responsible for this proposed constructlon activity, I will abide by licable laws and requirements that govern Owner-Builders as well as employers agree to notify the issuer of this form immediately of any additions, deletions, or changes to any ol the ation I have provided on this form icensed contractors are regulated by laws designed to protect the public. ll 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 lo understand that il an unlicensed Contractor or employee ol that individual or lirm is injured while working on your property, you may be held liable Ior damages. lf you obtain a permit as OwnerBuilder and wish to hire Contactors, you will be responsible for verilying whether or not those Contractors are properly licensed and the status ol their workers' compensation insurance coverage. Before a building permit can be issued, this lorm must be completed and signed by the property owner and returned to the agency responsible fo r issuing t permit. Arote: A copv of the propertv owner's driver's license. rm other veri to the ,s uired to be resented when the It is ven the o Signature of Property Date c*"/t * Print name ol Own Ll)7-7 AU ORIZATION 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 1or, sign, and file 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 that I am the property owner for the address listed above and I personally filled out the above information and certily its accuracy. Property Owneas Signature Date Print Name ol Owner Note: A copy ol the owner's driver's license, form nolarizalion, or other verificalion acceptable to the agency is required to be presented when the permit is issued to verity the properly owner's signature. SANTA ANA CITY COUNCIL mour do@sanla-an a.oro Mayor P.o Tem. Ward 2 m martrne2@sanla'ana oro vsarmlenro@sanra ana.ora solono@sanra.ana.oro dbenavrdes@sarra.ana oro iv lleoas@santa.ana oro sr naiero@sanra'ana oro t