407 W Santa Clara Ave - Misc. Permit

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ijcensed subcontractors and the number o{ structures does not exceed tour within any calendar years, or all of the work is . 'perf ormed under contract with a licensed general building Contractor. tl4 -/'tz L l understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustaihed by any subsequent owner(s) that result from any latent conslruclion defects in the workmanship or materials.b--\ - 9. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue Service, the United States Small Business Administration, the Calilornia Department of Benefit Payments, and the California Division of lndustrial Accidents. I also understand I may contact the Calilornia Contractors' State License Board (CSLB) at 1 -800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. Y- rc.I am aware ol and consent to an Owner-Builder building permit applied {or in my name, and understand that I am the oarlv leqallv and lirranciallv respon aooiess, {01 U.Swra, Zh<.rr sible lor oroDosed construction activitv at lhe lollowino A.f E.' (,..^s'r A Nrorr CA9+?o 9 " l, -,--\" lt.I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. 6. tagree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the ihlormation 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 ol 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 properly licensed and the status ol their workers' compensation insurance coverage. Belore 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. /Vore.'A coDv of the DroDertv wner's driver's license. form notarization, or other veri tca tion acceDtable to the aoencv is required to be ted when t.he Detmit is issued to the owner's Signature of Property Own Date Ur' n 4q Print name of Owner i":Z AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Properly Owner, the execution ol which I understand is my personal responsibllity, I hereby author ze the fol owing person(s) to aci as my agent(s) to apply for, sign, and file the documents necessary 10 obtain an Owner-Buider Permit for my project. Scope ol Construction Project (or Description of Work) Project Location or Address Name of Authorized Agent Address of Authorized Aoent 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 oul the above information and certify its accuracy. Property Owner's Signature Date Print Name ol Owner Note: A copy ol the owner's driver's license, torm notarization, or other verilication acceptable to the agency is required to be presented when the permit is issued to verify the properly owner's signature. SANTA ANA C]TY COUNC L mouiido@sanla ana oro Mayor Pro Teh. Ward 2 m man neu @sanla ana oro Vrcenre Sam enro vsarmrenlo@sanra'ana oro lsolqi!@sa!.la:ala dbenav dcs@safla ana oro ivile9as@rda:ala.sl naiero@sanla.ana.oro