2210 N Laird St - Misc. Permit - Laserfiche WebLink

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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 performed under conlract with a licensed general building Contractor. Vf 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 financial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or materials. i'..-}ll 9. I understand I may obtain more inlormation regarding my obligations as an "employer" from the lnternal Revenue Service, the United States Small Business Admrnistration, 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.oov for more inlormation about licensed contractors. _41i-t O. I am aware of and consent to an Owner-Builder building permrt applied for in my name, and understand that I am the party legally and financrally responsible for proposed construction activity at the Iollowing address: SFI f f. I agree that, as the party legally and {inancially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. ]LLLf Z. f agree to notif y the issuer of this form immediately ol any additions, deletions, or changes to any ol the irito/mation I have provided on this lorm. 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 il an unlicensed Contractor or employee ol that individual or firm is in]ured 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 verilying 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 torm must be completed and signed by the property owner and returned to the agency responsible lor issuing the permit. Note.'A coDv ot the propertv wner's driver's license. form notarization. or other tion acceDtable to the aoencv is reouired to be Dresented when the Dermit is Signature of Property Owner Date:ft.t I 49 Print name ol Owner CA i.tr.-l r 0+\F AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution ol 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-Buiider Permit for my project. Scope of Construction Project (or Description of Work) Project Location or Address Name of Authorized Agent Address of Authorized Agent Phone Number of Authorized Agent I declare under penalty ol periury that I am the property owner lor the address listed above and I personally filled out the above intormation and certily its accuracy. Property Owner's Signature Date Print Name of Owner Note: A copy ol the owner's driver's license, tom notarization, or other veritication acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. SANTA ANA CITY COUNCIL moulido@sanla-ana or. Mayor Pro Tem. Ward 2 mmar! nez@sa.ra ana.oro vrcenre Sarmienlo vsarmrenlo@sanla.ana oro isglo!io@a4!:@a4q dbenavdes@sanlaana.oro iytJeC!S@!39!:a!3 strnaero@sanla.a.a oro issued to verifv the Drooertv owner's sionature.