2217 S Salta St - Misc. Permit - Laserfiche WebLink

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nsed subcontractors and the number of structures does not exceed lour within any calendar years, or all of the work is ormed under contract with a licensed general buildi /1 //8. I understand as an Owner-Builder if I sell the ng Contraclor. property for which this permit is issued, I may be held liable for any fl ancial or personal injuries sustained by any subsequent owner(s) that result from any latent construction delects in the rkmanship or materials 9. I understand I may obtain more information regarding my obligations as an "employea'from the lnterna! Revenue rvice, the United States Small Business Administration, the California Department of Benefit Payments, and the Division of lndustrial Accidents. I also understand I may contact lhe Calitornia Contractors' State License Board 1-800-321-CSLB (2752) or www.cslb.ca.oov f or more information about licensed contractors I am aware of and consent to an Owner-Builder building permil applied tor in my name, and understand that I am egally and financially responsible for proposed constructlon activity at the following 1. I agree that, as the party legally and financially responsible lor this proposed construction activity, I will abide by icable laws and requirements that govern Owner-Builders as well as employers. 2. I agree to notify the issuer ol this lorm immediately of any additions, deletions, or changes to any of the ormation 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 OwnerBuilder 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 lorm must be completed and signed by the property owner and returned to the agency responsibl e r issuing th it. /Vote.' A copv of the propertv owner's driver's license, torm notarization or other veri wh issued to the o Signature of Property Date 5-e> -a0/7 Print name of Owner Onzct,q 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 acl as my agent(s) to apply for, sign, and file the documenls necessary to obtain an Owner-Builder Permit for my project. Phone Number ol Authorized Agent ldeclare under penalty ot periury that I am the property owner for the address listed above and I personally filled out the above inrormation and certily its accuracy. Properly Owneas Signature Date Print Name of Owner Note: A copy ot the owner's driver's license, torm notarization, ot other verilication acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature. ) . !-r .: t.!.,r, n..1,,.ir..,,r,r.f: SANTA ANA CITY COUNCIL ss natu mouldo@sanla ana oro [,layor Pro T6m, Ward 2 m man nez@sanra ana.oro V cente Sa.mre,rto vsarmie.to@santa-ana.oro 6oloro@sanla-an6 oro ScopeolconStructionProject(orDescriptionoIWork): Proiect Location or Address: Name of Authorized Agent: Address of Authorized Agent: P David Beravides Juan Villeqas Sal Trnalero Ward 4 Ward 5 Ward 6 dbenavdes@sanraa.a.oro jyine$s@sada:a!@ slnaiero@sanla-anaoro