2921 S Daimler St - Misc. Permit

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financial workma t^\lzd I understand as an Owner-Builder if I sell he property for which this permit is issued, I may be held liable for any lor personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the nship or materials. Mn , understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Servrce, the United States Small Business Administration, 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) al 1-800-321-CSLB (2752)or www.cslb.ca.qov for more information a bout licensed contractors LW)r the'party cpm oensatron insurance coverage. $1B"for" a building permit can be issued, this form must be compt\ returned to the agency responsible for issuing the permit. /Vofe: I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am legally and financially responsible for prop osed construction activitv atM"-the followino address ? fulzll .l agree that, as the party legally and financially responsible for this proposed construction activity, I wil abide by all applicable laws and requirements that govern Owner-Builders as well as employers. $2(Z f agree lo notify the rssuer of this form immediately of any addations, deletions, or changes to any of the information 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 tinancial 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 wi be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' eted and signed by the property owner and form notarization. or other verification acceDtable to the adencv is reouired to be Dresented when the permit is Signature of Property Owner Gar*u. af:+L f Date /o Print name of Owner frilo 3 Zo,,t H AUTHORIZATION OF AGENT TO ACT ON PROPERW 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 file the documents necessary to obtain an Owner-Builder Permit for my project. e l.rl,rr<^-\,?,-t'U to the ner's Scope of Construction Project (or Description of Work).rL .),F t, Project Location or Address 21tt l)q,u,Jo. 9+e*,,-ta.nl,o,b,t A-c,<-b4 Name of Authorized Agent 7o [i^- ^J Address of Authorized Agent l{ tf Le<t ^) Phone Number of Authorized Agent ?t\_7.{-) ^ 1;6l I declare under penalty of periu ry that I am the property owner for the address listed above and I personally filled out the above information and certily its accu "&-z^-.-9 AJ---Property Owner's Signature Print Name of Owner: 5 A4lpo,Z 2"/A Note: A copy of lhe owner's drivor's license, form notaization, or other verificaaion acceptable to the agency is required to b6 presented when the permit is issuad to verify tha propsrly owner's signature. PLinkiWP5l/Counter Aclivity/Assembly Eills/Nolice to Property Form 03-13-2014 SANTA ANA CITY COUNCIL M,guerA Pu d( i S.,rnsFo M.yq i VayrPolm Warc6 i vPurdo@sanlE.a.a o.o ; ST'ia'so@3anra-an. o'o i Mmeu@alas&6-ana oo P Ooeo Benaeo6 ii ward r i i O8a&d66sanla-ea d i A coDV of the DroDedv owner's drivet's license, Date: V'rcenl F Samenb vsamenro@sanB-ana o.o