1710 W Eleventh St - Misc. Permit

Home Browse Search

_80,_S. t understand I may obtain more information regarding myobligations as an'employef from the lnternal Revenue Ser- vice, the United States Small Business Administration, the Califomia Department of Benefit Payments, and the Califomia Divi- sion of lndustrial Accidents. I also understand I may contacl the Califomia Contractors' State License Board (CSLB) at 1-80G 321-CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors. _QLl o I am aware of and consent to an Owner-Builder building permit applied for in my name, and undersland that I am the party legally and financially responsible for proposed construction activity at the following ad- dress: . DD 1 f. 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 govem Owner-Builders as u/ell as employeB. _q912. I agree to notiFy the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contadors are regulated by laws designed to protect the public. lf you contract Wth someone who does not have a license, the ContractoB' State License Board may be unable to assist you with any linancial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil courl. lt is also important for you to understand that if an unlicâ‚¬nsed Contractor or employee of that individual or frm is injured wtlile working on your property, you may be held liable for damages. lf you obtain a permit as Owner-Builder and Wsh 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. Botoro a building pomlt can bo is3uod, thl3 fo]m murt bo comploted and 3ignod by the property ownor and rotumsd to the agoncy rcsponsible for l3sulng tho pormit Note: tlon. ot othet verillcatton acceotdble to the aoencv ls tBoulrl|d to be presented when the oermlt ls lasued ao vedfv the Signature of Property Owner oarre. 4t24n020 Print name of Owner DUNG DO AUTHORIZATION OF AGENT TO ACT ON PROPERry OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of wtrich I understand is my personal responsibility, I hereby authorize the following person(s) to acl as my agent(s) to apply for, sign, and file thc documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Projecl (or Description of work):275 SQUARE FEET WORKSHOP Proiect Location or Address 1710 W 11TH STREET SANTA ANA, CA 92703 Name of Authorized Agent:ouoc Do Address of Aulhorized Agent:121 8 CAMDEN PL SANTA ANA, CA 92705 Phone Number of Authorized Agent: I declare under penalty of pedury that I am the property owner for the address listed above and I personally lilled out the above information and certify its accuracy. Property Owne/s Signature Date 4t2412020 Print Name of Owner:DUNG DO Note: A copy of the ownef s drlverls license, form notartza0on, or other verlfica0on acceptable to the dgency is re- qulrcd to be presented whan the pe'7,,it is bsued to verily ahe propefty owner's slgnature.