2360 N Riverside Dr - Misc. Permit

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licensed subcontractors and the number of structures docs not exceed four within any calendar years, or all of the work is pe ed under contract with a licensed general building Contrector ncial I understand as an Owner-Builder if I sell the property for whlch this permit is issued, I may be held liable for any or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the anship or materials I understand I may obtain more information regarding my obligations as an "employef'from the lnternal Revenue rvice, the United States Small Business Administration, the California Department of Benefit Payments, and the lifornia Division of lndustrial Accidents. I also understand I may contact the California Conlractors' State License Board (c ) at 1-800-321 -CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am party I llv and L' financ yre onsible fo1 sed construction activ ity at the following agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by al plicable laws and requirements that govern Owner-Builders as well as employers I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the ation 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' 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 responsibf e for issuing the pcrmit. /Vofe.' A copv of the propeftv owner's driver's license. form notarization. or other verifica tion acceDtable to the aoencv is reouired to be Dresented when the permit is the owner's Signature of Property Ow Date +\1 Print name of Owner l'^AV]/1.AY), POect Location or Address Name of Authorized Agent Address of 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 of the owner's diver's license, form notarization, or other verification acceptable to the agency is required to be presented when the permil is issued to verify the propedy owner's signature. P nr ,/.lpa,r il.u.i0A.1!.1yrA3.cnl-. lil s,NolL.. r. pr.p."1! riE i,:l i4 :1415 SANTA ANA CITY COUNCIL mpu do@sanla ana oro Mayor Prc Ten ward 2 mimadi.ez@sanla-ana oro vsarmrenlo@sanla-a.a oro isoloio@saiia-ana.oro P Oavid Benavdes dbenavidss@sanla-an..oro iv eoaslOsanla-a.a oro stina ero@sanla-ana.oro 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 Ille the documents necessary to obtain an Owner-Builder Permit for my project. ScopeofconStrUctionProject(orDeScriptionofWork): \q 5 Phone Number of Authonzed Agent: