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1817 W Washington Ave - Misc. Permit
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1817 W Washington Ave - Misc. Permit
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Last modified
7/27/2021 11:22:44 AM
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7/27/2021 11:22:29 AM
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Misc. Permit
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1817 W Washington Ave
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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 <br />performed under contract with a licensed general bullding Contractor. <br />\ 6 A. t understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any <br />financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the <br />workmanship or materials. <br />)G 9. I understand l may obtain more information regarding my obligations as an "employer" from the lnternal Revenue <br />Service, the United States Small Business Administration, the California Department of Benefit Payments, and the <br />California Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board <br />(CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. <br />\, r, '10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am <br />tne party legally and financially responsible for proposed construction activity at the followrng <br />address: 16t 1 W VJ,.rshinql oa A,t<- <br />9+ ll.I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by <br />all applicable laws and requirements that govern Owner-Builders as well as employers. <br />5L1Z.I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the <br />information I 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 <br />have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain <br />as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. lt is also important for <br />you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your <br />property, you may be held liable for damages. lf you obtain a permit as Owner-Builder and wish to hire Contactors, you will <br />be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' <br />compensatlon insurance coverage. <br />Before a buildlng permit can be issued, this form must be completed and signed by the property owner and <br />returned to the agency responsible for issuing the p ermit. Notej A copy of the property owner's driver's license, <br />fgrm notarization, or other verification acceptable to the asency is required to be presented when the permit is <br />ssued fo the owner's s nature. <br />Signature of Property <br />Print name of Owner <br />aate'.0'1 Lo <br />{rQ- <br />AUTHORIZATION OF AGENT TO ACT ON PROPERW OWNER'S BEHALF <br />Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the <br />following person(s)to act as my agent(s) to apply for, sign, and flle the documents necessary to obtain an Owner-Builder Permit for my <br />project. <br />Scope of Construction Project (or Description of Work) <br />Project Location or Address <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 Date: <br />Print Name of Owner: <br />Note: A copy of the owner's driver's license, form notarization, or other verification acceptable lo the agency is required to <br />be presented when the permit is issued lo verify the properly owner's signature- <br />,r r fri:l rlr.... /,.r,,t.r:rr,.l-rti -1!tr..i. ir.r'r <br />SANTA ANA CITY COUNCIL <br />moulido@santa-ana.oro <br />Mayor Pro Tem, Ward 2 <br />mrmarti.ez@sanla-ana oro soloiolasaola ana.oro <br />P Oavrd Be.avides <br />dbenavrdes@sanla a.6oro ivilleoas@santa-ana.oro slinalero@santa-ana orosarme.lo@sanla ana oro
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