2202 N Poplar St - Misc. Permit (3)

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licensed subcontractors and the number of structures does not excbed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. Q' f8. I 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 owne(s) that result from any latent construction defects in the workmanship or materials. 'l ,4?_t/ L l understand lmayobtain more information regarding myobligations as an "employer" from the lnternal Revenue Sdrvice, 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 (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors. ej_10.1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that lam the party and financially respo nsible for proposed constructio at the following a6add re S â‚¬ Q 't, I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by -ll Spplicable laws and requirements that govern Owner-Builders as well as employers. â‚¬--L,, I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the -inf6rmation 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, 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 to understand that if an unlicensed Contractor or employee of 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' com pensation 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 p ermit. /Votei A copv of the property owner's driver's license, form notarization, or other verification acceptable to the ao enc ,s reo to be Dresented when the oermit is issued to verifu the owner's sionature. Signature of Property Own oa.,^orlz-/t k Print name of Owner u t /,'Vl e t'1 .-) 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 llle the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construction Project (or Description of Work) Name of Authorized Agent Address of Authorized Agent:_ Phone Number of Authorized Agent: I declare under penalty of petury 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 of the owner's driver's license, form noaarization, or other verification acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. e -r i j,tr a-j.i._A.r,,,t A:::1i )i_:,::. f!j... r.|-',r;:_i, i:. r al 'tr:ja 1: SANTA ANA CITY COUNCIL moo do@santa ana.oro Mayor Pro Tem, Ward 2 mimarl nez@santa-ana oro Vicente 56m ento vsarmienlo@sa.ta-ana.oro so oroAsanla 3na oro P. Davd Benavides dbenavides@sanIa-ana oro iv eoas@sa.t.-ana o.o sl naero@sante ana oro Project Location or Address: _