911 N Olive St - Misc. Permit - Laserfiche WebLink

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licensed subcontraclors and the number of structures does not exceed four within any calendar years, or all ol the work is - performed under contract with a licensed general building Contractor. -O-U. , understand as an Owner-Builder i, I sell the property for which this permit is issued, I may be held liable Ior any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. C--g I understand I may obtain more information regarding my obligations as an "employer" Irom the Internal Bevenue Service, the Uniied States Small Business Administration, the California Department of Benelit 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 f or more information about licensed contraclors. Da: -fi. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party legally and financially responsible lor proposed construction activity at the following address /1La_]t1.1 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. ClZ.I agree to notily the issuer ol this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Llcensed 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 impoftant for you to understand that if an unlicensed Contractor or employee ol that lndividual 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 verlfying 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 lo the agency responsible for issuing the permit. Note.' A copv ot the propertv ownet's driver's license. torm notarization. or other veritication acceDtable to the aoencv is required to be sented when the Dermit is owner's Signature of Property Owner Date g Print name of Owner 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 responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and lile the documents necessary to obtain an Owner-Builder Permil lor my U Scope of Construction Project (or Description of Work):- Prolecl Location or Address Address of Authorized Agenl Phone Number of Authorized Agent ldeclare under penalty ol perjury that I am the property owner lor the address listed above and I personally filled out the above information and certily its accuracy.Date:_ Prinl Name ol Owner Note: A, copy ol the owner's driver's license, form notarization, or other veritication acceptable to the agency is required to be presented when the permit is issued to verity the prcperty owner's signature. SANTA ANA CITY COUNCIL moul do@sa.ra-ana oro Mayor Pro Tem, Ward 2 !oEa!I!e?@!aqa:a!@ isoloro@sanla.ana.oro P. Oavid Benav des dbenalrles@sarla:ara.a4 snnaEro@santa ana.orovsarm e.ro@sanla ana oro vr lcoas@santa ana.o/o Name ol Authorized Agent: Property Owneas Signature: