2045 W Martha Ln - Misc. Permit - Laserfiche WebLink

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licensed subcontractors and the number ol structures does not exceed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor.t\ 4fSl , understand as an Owner-Builder if 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 lrom any lalent construction defects in the workmanship or materials. 4f |[t. , understand I may oblain more information regarding my obligations as an "employea' from the lnternal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the Calitornia Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321 -CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors.r)n JJ44t tt tO. I am aware of and consent to an OwnerBuilder building permit applied for in my name, and understand that I am the party address: legall and f inanciall respo slble for prop osed construction activit v a the f llowin 06.01-r 6- QtlLa,1. 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 govern Owner-Builders as well as employers.Alr UtsKt2 I agree lo 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 contractors are regulated by laws designed to protect the public. lf you contract with someone who does not have a license, ths Contractors' 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 court. lt is also important for you to understand that if an unlicensed Contractor or employee ol 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 permit. Arote.' A copv of the DroDertv ownet's driver's license. tion or other to the ired to be ted when the it is dto the ss,c/t/t rSignature of Property Owner Date: Print name ol Owner 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 Permil for my project. Scope of Construction Project (or Description of Work) Project Location or Address Name ol Authorized Agent Address of Authorized Agent Phone Number ot 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 certify its accuracy. Property Owner s Signature Date Print Name of Owner Note: A copy ol the owner's driver's license, lorm 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. SANTA ANA CITY COUNC]L mbuIdo@sanla-aoa oro Mayor Pro Tenr ward 2 mimanne2@sania ara.oro vsarmiento@sanla ana.oro lsoor o@sa.la ana oro dbe.avdes@sanla a.a oro lyiXe@S@Sada:a!@ slrnaero@safla ana.oro