509 S Forest Ave - 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 ol the work is performed under contracl with a licensed general buildind Conlractor. Q4i unAerstand as an Owner-Builder if I sell the propertyior wnich this permit is issued, I may be held liable for any financial or personal lnjuries sustained by any subsequent owner(s) that result from any latent consfuction defects in the workman ip or materials 9. I understand I may obtain more inlormation regarding my obligations as an "employea'from the lnternal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the Calilornia Division ol lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800-321-CSLB (2752) or lvww.cslb.ca.oov lor more information about licensed conlractors., ,-2. A.r---: 10. I am aware ol and consent lo an Owner-Builder building permit applied lor in my name, and understand that I am for oroDo+' '4 v/<__ uction aqtivitygart+p-A followino ^/4 -c.4. 9 z-7.3the oartv leoallv and financiallv adoress: " ?O? 5,'sib le sed constr at the S 1. I agree that, as the party legally and financially responsible lor this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. ^ t-12.1 agree to notify the issuer of this form immediately ol any additions, deletions, or changes to any ol the inlormation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. lf you contracl with someone who does not have a license, the Contractors' Slate 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 civll court. lt is also important for you to understand that if an unlicensed Contractor or employee of that individual or rirm is injured while working on your property, you may be held liable for damages. ll 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. /Vote.'A coDv of the Dropertv wner's driver's license, torm notarization,or other verification acceDtable to t aoencv is reouired to be Dresented when the Dermit is Owner to nature. Date f-7- t 7Signature of Property Print name of Owner /+kfzo,,/ 'f" PE/?.t L:i 4- AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Properly Owner, the execution of which I understand is my personal responsibiiity, I hereby authorize the lollowing 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 Scope of Construction Project (or Description of Work)U; i,/Lot+/3 i QoEf u cLo {2 E 5,f<:1-4/z *tt//rt t/-r/* @-tu3 Name of Authorized Agent ( eci [,'de-c* Address of Authorized Ag "", fof -9'C>r- 4/z- -9fu /r lr/*c4 E"-v OJ I declare under penalty oi perlury that I am the property owner for the address listed above and I personally filled out the above iniormation and certi fy lts accuracy Date: ,'Y- / 2Pperty Owner's Signature rinr Name oi owner , A n-AAl/a- (erz*L7* Note: A copy of the owner's driver's license, torm notarization, or olher verification acceptable to the agency is required to be presented when the permit is issued to verily the property owner's signature. SANTA ANA CIT/ COUNCIL moul do@sanra-ana. oro Mayor Pro Tom, Ward 2 mimarl ne2@saola.ana.oro vicenre Sarrnlonlo vsarm ento@sanla.ana.o.o isdglg@salE:al3 plq P Davrd Benavides dbenavrdes@santa.ana.oro iYile9as@lada:a&-eq Ei!4ie!o@!ada:a@rg Project Location or Address: T- phoneNumberorA"tno,*aesu"t, 7 ? f - 7OL - 7 / Z' I