639 N Fairview St - Misc. Permit

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epa licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work ls performed under contracl with a licensed general building Contractor' B. I 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 sustained by any subsequent owne(s) that result from any latent construction defects in the workmanship or materials. /)/ / 9. lunderstand lmavobtain more information regarding myobligations as an'employer" from the Internal Revenue s-ffitce. tne United States Smalt Business Administration, the California Department of Benefit Payments, and the California Division of lndustraal 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. 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am rty legally and financially responsible for proposed construction activity at the following address. Q,,I agree that, as the party legally and financially responsible for this proposed construction activity, lwill abide by ble laws and requlrements that govern Owner-Builders as well as employers.all applica eZZ. t agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the lnformation I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. It you contract with someone who does not have a ljcense. 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 imporiant 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 will be responsible for verifying whether or not those Contractors are properly licensed and lhe status of their workers' com pensation insu.ance coverage. Before a building permit can be issued, this form must be completed and signed bythe property owner and returned to the agency resp onsible fo ermit. Note A coDv of the DroDertv owner's driver's license. form no nz tion or C ,s uired to be ented when the ermit is isgued to verifu the oroDertv o wner's siqnature. Signature of Property Print name of Owner Owner ?/./, r VA,LLL-t"b.- -Jl- (srra<.| alo"\rt.t,l fr. L,^il- Date I AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Exctudinq the Notice to Propcny Owner, the execution of which I understand is my personal responsibility, I hereby authorize the fo ov ng person(s) to act as my agent(s) to apply for, sign, and flle the documents necessary to obtain an Owner-8u lder Permrt Ior my proiect. Scope of Construction Project (or Description of Work) catton a /4b5 F*)rV\C\..../5a-A o'tP.olecl !ocauon or Address NarmL. oI Authorize.i Ag.r nt rhAric rh",'r.'ie ? to-re Gpr.ln Address of Authorized Agent Fftlrr1.- 5 /(e Al)^ otos1 0-1L-7t,3 Phone NLrmbe. of Authori?ed I declare under oenalty of periury that I am the property owne the addre information and certify jls accuracy Property Owner's Sign ature above and I personal filled ut the above Date z h,*b.-Prinl Name of Owner 0-t r rh Note: A copy of the owner's driver's license, form notarizati on. or other verification acceptable to the agency is requircd to SANTA ANA C IY COUNCIL P o3vd 8â‚¬nav'de5 dbâ‚¬.audâ‚¬5'tDs$[a-ane.o.o lvill6oasOsanb-ana o.o nrA be prcsented when the permlt is issired to verify the propeiy owner's signature.