Even-1972-1976 E McFadden Ave - Misc. Permit

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licensed subcontractors and the number of slructures does not exceed ,our within any calendar years, or all of the work is performed under contract with a licensed general building Contractor. -@. ,understand as an Owner-Builder if I sell the property {or which this permit is issued, I may be held liable for any flhar6ial or personal injunes sustained by any subsequent owner(s) that result lrom any latent construction defects in the workmanship or materials.-'-\ (M I understand I may obtain more information regarding my obligations as an "employer",rom the lnternal Revenue Wice, the United States Small Business Administration, the California Department of Bene{il Payments, and the California Division of lndustrial Accidents. I also understand I may contact the Calilornia Contractors' State License Board (CS LB at 1-800-321-CSLB (2752) or www.cslb.ca.oov lor more information about licensed contractors 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 address: and finan cially responsible for proposed construction activity at the tollowing ,.An/'rF A+JAb,{4-+2At 1. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by a ap licable laws and r equirements that govern Owner-Builders as well as employers I agree to notify the issuer of this form immediately of any addrtions, deletions, or changes to any ol the inlormation I have provided on this lorm. 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 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 coun. 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 issue s form mus completed and signed by the property owner and returned to the agency responsib u h pe . Note: A coDv of the propertv ownet's driver's license, to c ,s ul when the it is issued to veri the ro Signature of Property Owner Date: 1 lo tr.O.J2r'Aa H"- turz-E- AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Propeny 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 1or, sign, and lile the documents necessary to obtain an Owner Builder Permit for my project. Scope of Construction Project (or Description of Work)+D le .2c-\\J.jro.r\ odtk ti 2 {"1?G r-ocation or eoarlS!? ' L"l1Project r 4".\i1c,,-t {1S Name ol Authorized Agent \o^:d u\>Q{.uJ,n Address of Authorized Ag ent: 5"o,r<.' Phone Number ol Authorized Agent ldeclare under penalty of perjury'th intormation and certiiy its accuracy. the address listed above and lpersonal Date: 1 'l'::*l^,e above 1 Print Name of Owner: Note: A copy ot the ILU+D l{at2a174n,?*?F- to the agency is required toowner's driver's license, form rization, or other verilication acceptable be presenled when the permit is issued to verily the property owner's signature SANTA ANA C TY COUNC L ,l l', mo!lido@san16'ana or. Michele Manrnez Mayor Pro Tem. Ward 2 Ersi!-me?@sa!&:a!a.e!9 vsarm'enro@sanra ana oro isolono@sanla-ana.oro P. Dav d Benavides dbenavdes@sanla ana.oro ivilleoas@santa-Fna.oro st.alero@santa.ana.oro Print name of Owner *lD 4..^ L.fr Qz?<x Property Owners Signature: