914 S Bewley St - Misc. Permit - Laserfiche WebLink

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licensed subconlractors and the number of structures does not exceed four within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. Ll.l U. , understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any Iinancial or personal injuries sustained by any subsequent owne(s) thal result from any lalent construction defects in the workmanship or materials. .l141g. I understand I may obtain more informalion regarding my obligations as an "employef'lrom the lnternal Revenue Service, the United States Small Business Administration, the Calitornia Departmenl ol Benelil Payments, and the California Division of lndustrial Accidents. I also understand I may contacl the Calilornia Conlractors' State License Board (CSLB) at 1-80O-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. I LLJ f O. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the pa-rty legally and Iinancially responsible for proposed construction activity at the following o L ['J t t. I agree that, as the party legally and linancially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner-Builders as well as employers. _LMZ. t agree 10 notily the issuer o{ this Iorm immedialely of any additions, deletions, or changes to any o, the information I have provrded 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 assisl you with any financial loss you may sustain as a result ol 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. 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 of their workers' compensation insurance coverage. Before a building permit can be issued, this lorm must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. Note.' A copv ol the propertv owner's driver's license. ton or other the ,s ted when the Signature of Property Owner Date: Print name of Owner Loc tJ+ eXerJ AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, lhe execulion of which I undersland is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file lhe documents necessary lo obtain an Owner Builder Permit lor my project. Scope of Construction Project (or Description of Work) Address of Authorized Agent:- Phone Number ol Authorized Agent I declare under penalty ot periury that I am the property owner for the address listed above and I personally filled out the above information and certify its accuracy. Property Owner's Signature Date Prlnt Name of Owner Note: A copy ot the owner's driver's license, torm notarization, or other verification acceptable to the agency is required to be presenled when the permit is issued to verity the propetty owner's signature. r, r, ir.r,rar i.lfrlrlr ir. :,' hi,r. iulri. . ^.:::i, t. r, -,, t, r" rJ.2: rrl SANTA ANA CITY COUNCIL mpulido@santa.ana or. Mayor Pro Tom. Ward 2 trl4atr-os@saqa:a!!..a4 P Davd Benavides dbenavides@sanla-ana.oro jvine!r9@sada:a!@ sllnaiero@sanla-ana orovsarmrenro@sarra ana.o.o Proiecl Location or Address: - Name of Aulhorized Agent: - irqlpla@salh:alr.la