Laserfiche WebLink
the address listed above and I pe <br />tA 9. I understand I may obtain more information regardingr'ny obligations as an "employer" from the lnternal Revenue Ser- <br />vice, the United States Small Business Administration, the California Department of Benefit Payments, and the California DivF <br />sion of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1 -800- <br />32'l-CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors. <br />WA ,0. I am aware of and consent to an Owner-Builder building permat applied for in my name, and understand that I am the <br />!*."5 Y ii 'f i\]iro"'5"'{Ro"*ogffrSl'ctivry€t the ro,owiffid- g a-D r <br />Licensed contractors are regulated by laws designed to protect the public. lf you contract with someone who does not have a <br />license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of <br />a complaint. Your only remedy against unlicensed Contractors may be in civil court. lt is also important for you to understand <br />that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held <br />liable for damages. lf you obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible for verifying <br />whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. <br />proDertv ow ner's sidn atu re. <br />Signature of Property Owner rolzzlrT <br />Print name of Owner \\e <br />Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize <br />the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder <br />Permit for my project. <br />Scope of Construction Project (or De ption of Work) <br />Project Location or Address <br />Name of Authorized Agent <br />Address of Authorized nt: <br />Phone Number of Au rized Agent <br />nalty of perjury that I am the property owner ally filled out the above <br />information a certify its accuracy. <br />Prope Owner's Signature te <br />P nt Name of Owner: <br />Note: A copy of the owner's driver's license, form notarization, or other <br />quired to be presented when the permit is issued to verify the property o <br />acc eptable to the agency is re- <br />signature. <br />,l <br />kS f f . I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all <br />applicable laws and requirements that govern Owner-Builders as well as employers. <br />rl <br />k# f Z t agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I <br />have provided on this form. <br />Before a building permit can be issued, this form must be completed and signed by the property owner and returned <br />to the agency responsible for issuing the permit. ,Vote.' A colJv of the properTv owner's driver's license. torm notariza- <br />tion. or other verification acceptable to the aoencv is reouired to be presented when the permit is issued to verifv the <br />Date: <br />AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF <br />I declare under