1809 W Glenwood Pl - Misc. Permit

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licensed subcontractors and the number ol structures does noi exceed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. .4 (' 44. I understand as an Owner-Builder i{ 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 {rom any latent construclion defects in the workmanship or materials. /!a:F. I understand I may obtain more information regarding my obligalions as an "employer" from the lnternal Revenue Serr/rce, the United States Small Business Administration, the Calilornia Department of Benefit Payments, and the California Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-32'1-CSLB (2752) or w1i\,1 .cslb.ca.oov for more inlormation about licensed contractors. /{-l.:=tl"the party address: I am aware of and consent to an Owner-Builder building permit applied lor in my name, and understand that I am leg all and financial responsible f or p ro p osed construction activity at the following -L:)1.1 agree that, as the party legally and financially responsible for this proposed construclion activity, I will abide by rall aFplicable laws and requirements that govern Owner-Builders as well as employers. ,. /J_Li2 I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any ol the/ inf ormation I have provided on this f orm. 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 ol 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 lirm is injured while working on your property, you may be held liable for damages. ll 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' compensalion 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 issuin it. A/ofe.' A coDv of the Dropeftv owner's driver's license, za tion or other veritica ,s uired to when t issued to veri the o s re Signature of Property Print name of Owner Owner r Date:5)t )zot? ,e.\ AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of whlch I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply ior, sign, and lile the documents necessary lo obtain an Owner-Builder Perm t lor my proiect. Scope of Construction Project (or Description of Work) Projecl Location or Address Name of Authorized Aoent Address of Authorized Aoent I declare under penalty of perjury thal I am the property owner for the address listed above and I personally filled out the above informalion and certify its accuracy. Properly Owner's Signature Date Print Name oi Owner: Note: A copy of the ownet's d ver's license,lorm notarization, or other veritication acceptable lo lhe agency is required to be presented when the permit is issued to verity the propeiy owner's signature- ') ,i.j'\": .1r,. i.r.. ii.-r'rrri ! ,. :i.ii.i..:, irt: r'ir- irllii SANTA ANA CITY COUNCIL moul dd(asanla.ana oio Mayor Pro Tem. ward 2 minan neu @sa.la ana.oro vcente Sarmienro vsam enlo@sanla-ana.oro solorio@sanla-ana oro d!eE!.0es@s?!E:3 I'lleoas@santa-ana.oro slrnaiero@sanla-ana.oro Phone Number ol Authorized Agenl: