3614 W Sunswept Ave - Misc. Permit

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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. _lAA. f understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable tor any financial or personal injuries sustained by any subsequent owne(s) that result lrom any latent construction delects in the workmanship or materials. _VLr. t understand I may oblain more information regardrng my obligations as an "employer' from the lnternal Revenue Serrice. tne United States Small Business Administration, the Callfornia Department of Benefit Payments, and the California Division ol 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 lor more information aboul licensed contractors. t /F f O. I am aware ol and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible for proposed construction activity at the following address yfl- r t. I agree that, as the party legally and financially responsible for this proposed construclion activity, I will abide by all applicable laws and requirements thal govern Owner-Builders as well as employers. t/Il lZ. I agree to notily the issuer of this form immediately of any additions, 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 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 obtarn a permit as Owner-Builder and wish to hire Contactors, you will be iesponsible loi verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Belore a building per mit can be issued, this torm must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. i/ore A aoDv of the rtroncrlv o wner's driver t ,i.cn-se- torm notariza . or other veritication table to the aoencv is uired to be Dresented when the Dermit is Signature of Property Print name of Owner Owner Date: 06 l,/t /\11 t-\fr AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property following person(s) to act as my project. Owner, the execution of which I understand is my personal responsibility, I hereby authorize the agent(s) to apply for, sign, and file the documents necessary obtain an Owner-Builder Permit for my Scope of Construction Project (or Descri n o{ Work) Project Location or Address Name of Authorized Agent Address of Authorized Agen Phone Number of Autho Agent ldeclare under pen ol periury that I am the I personally filled out the above information and ify its accuracy. Property Ow Signature Date Pr nt Name ol Owner: Note: A copy of the be presented when t owner's s license,ation, or other acceptable to the agency is required to he is issued to the property ture emblyaLllsrNoucâ‚¬ to Pr.ped! r.rn oJz SANTA ANA CIry COUNCIL address listed aboveperty owner for mou do@santa.ana.oro Mayor Pro Tem, Wad 2 mima.l nez@sa.la-ana o.o !$IEG!]P@SA!.8:3!3!!!isolono@santa ana.oro jvllleGs@leDla:a!@ $!eiel!@sa!E:a!34l! issued to veritv the Dropertv owner's siqnature. P Davd Benavides dbenavldes@sanla-ana oro