2825 Dayna St - Misc. Permit - Laserfiche WebLink

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'licensed subcontractors and the number ol structures does not exceed four within any calendar years, or all of the work is .performed under contract with a licensed general building Contractor. nl' \lF A. I understand as an Owner-Builder if I sell the property lor which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent conslruction defects in the wo,lmanship or materials. [] g. f understand I may obtain more information regarding my obligations as an "employer" f rom the lnternal Bevenue 'Service, the United States Small Business Administration, the California Department oJ Benelit Payments, and the Californla Dlvision of lndustrial Accidents. I also understand I may contact the Calilornia Contractors' Slate License Board (CSLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. ^'t(Uo' 10. I am aware ot and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and fi n iall res nsible for.Drq ed nstru ion activity at the following address:7 iu d\- TE 11. I agree that, as the party legally and financrally responsible for this proposed construction activity, I will abide by all appljcable laws and requirements that govern Owner-Builders as well as employers. -Ltr\2. f agree lo notify the issuer of this form immediately of any additions, deletions, or changes to any oI the inlormation 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 il an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable lor 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 lorm must be completed and signed by the property owner and returned to the agency responsible lor issuing the permit. Nofe.'Aco DV of the DroDertv owner 's tlriver's liaense- n r cation to the ted when the il ls ssi natu lr?Signature of Property Owner Date 9 \b Print name of Owner Clrzfrc L Ia..to Y{<--, AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice lo 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 11le the documents necessary to obtain an Owner-Builder Permit for my project. Scope of Construclion Project (or Description of Work) Proiect Location or Address Name of Authorized Agent Address of Authorized Aqent Phone Number 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 ol the owner's driver's license, form notarization, or other verilication acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature- ,: r \f i,: r i...r',. ;i.. : \ ir ii :.i, r,ar ili ",., -( SANTA ANA CIIY COUNCIL mpulrdo@santa.ana.oro lvlayor Pro Tem, Ward 2 m marlrnez@sanla.ana oro Vi.enre sarm enro vsarmrenlo@sanla.ana.o.o isolono@sa.1a ana oro P. Davd Benav des dbenavdes@sanla ana.oro ivilleoas@sanla-ana.o.o !!-!aie!!@sa4a:!.!.a LWNpro