815 N French St - Misc. Permit - Laserfiche WebLink

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licensed subcontractors and the number of structures does nol exceed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor, -B- A. I understand as an Owner-Builder if I sell the property lor which this permit is issued, I may be held liable {or any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. fh 9- I understand I may obtain more information regarding my obligations as an "employea' f rom the lnternal Revenue Service, the Uniled States Small Business Administration, the California Department of Benefit Payments, and the Calilornia 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 Ior more information about licensed contractors. 1..fi." lO.l am aware ot and consent to an Owner-Builder building permit applied for in my name, and understand that I am fhe party legally and financially responsible for proposed construction activity at the following address: t,+ N. ir,1t.' Sz . Sc-.u,. As^ . ( O 9 z-) " r 1 1. 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. 4 iZ.t agree to notity the issuer of this form immediately ol any addilions, deletions, or changes to any of the 'infdrmation 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 10 assist you with any linancial 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. ll you obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible Ior verifying whether or not those Contractors are properly 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 lhe agency responsible for issuing the permit. Note: A copv of the propertv owner's driver's license, form notarization, or other verification acceptable to the aoency is required to be Dresented when the Dermit is er Date t lSignature of Property Print name of Owner â‚¬z- Eru <,O LVC 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 responsibilily, 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 Permil lor my project. Scope of Construction Project (or Description of Work) Project Location or Address Name of Authorized Agent Address of Authorized Agent Phone Number ol Authorized Agent ldeclare 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 ils accuracy. Properly Owner's Signature Date Print Name of Owner Nole: A copy ol the owner's driver's license, torm notarization, or other verification acceptable lo the agency is required to be presented when the pemit is issued to verity the properiy owner's signature. t-.: : tr /-j,..rl) ti:r rt.,| . (r 1. lri.1,r,:,r i :: . i : 1 :ti,l.j SANTA ANA CITY COUNCIL noulrdo@santa.ana oro lrayor Pro Tem, Ward 2 mroan'nez@saola.ana oro Vicenre Sarmiento vsarmrenlo@sanla.ana oro isolorio@sanla.ana.oro dbenav des@sa.la.ana.oro Nrlleoas@sanla-ana oro snnaie.o@santa.ana.or. issued to verifv the proDertv owner's sianature.