3221 S Lowell St - Misc. Permit - Laserfiche WebLink

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licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. -&L-+ ' understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any finbncial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. ,$JYS f understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, 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) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. t-L;o thb party I am aware of and consent to an OwnerBuilder building permit applied for in my name, and understand that I am leqallv and finrlrl nancially responsihle for proposed -<-/1 .Yr S. r\ - construction activ ity at the following address E, 1-r'q ,-"0-l q N f f I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by dll applicable laws and requirements that govern Owner-Builders as well as employers. lEf2.l agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the ihformation 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 impo(ant for you to understand that lf 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 propedy 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 responsible for issuing the permit. /Vofe.' A copv of the propertv owner's driver's license, otarization or other verification table to the a ,s uired to be ted when the it is Signature of Property Owner Date /c e Print name of Owner eN1- 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 file the documents necessary to obtain an Owner-Builder Permit for my project. Alc ?tplau Ar '/D(os I k-'l.oirâ‚¬..i Scope of Construction Project (or Description of Work) Project Location or Address:JeAl S, (ox,l/ 9f S A. 1tto7 Name of Authorized Agent .3AAGA:1. NpLAnl Address of Authorized Agent: Phone Number of Authorized Agent:'1rul - q51 - '-{D3 I 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 ? /roltgProperty Owner's Signature Date Print Name of Owner:?oBr,..l Note: A copy of the owner's diver's license, form notarization, or other veritication acceptable to the agency is required to be presented when the permit is issued to verify the propefty owner's signature. i)l irlr1t'lpll: a.!rie.A.! r !y A!3:mt,, ) 3 r.i5lr: c 1.1,r-tri/ f.- n i.:i i,1.Ua'1il SANTA ANA CITY COUNCIL MrguelA Pu do Michele Martrnez Vcenle Samenlo Jose So orio P Dav d Benavides Juan Villegas SalI najerc Mayor Mayor Pro Tem, Ward 2 Ward 1 Ward 3 Wa.d4 WErd 5 Ward 6 issued to verifu the propedv owner's siqnature. I