10183535 - Permit - Laserfiche WebLink

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"'l^6rrr*-*irt I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the wo#manship or materials.ilc-tlLg-l understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue SerVice, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Bodrd (CFLB) at 1-800-321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors.I k'tO.l am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the oartv leoallv and financiallv resoonsible for orooosed construction acti),ritv at the followino;;i ; ;: * "'22' 5 3-''' <8 "'' - >' ;+\ Z* *;7- " * * " " YH " /?+ " "/+; n- ( 4l- .-fu I agree that, as the party legally and financially responsible for this proposed construction activity, I will abade by 'allFpplicable laws and requirements that govern Owner-Builders as well as employers. ,M I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the r information 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 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 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 whelher or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. Bsfore a building permit can be issued, this form must be completed and signed by the property owner and returned to the agency responsible for issuing the permit. /Vo(e.' A copv of the propertv owner's driver's license. form notarization or other verification table the c ,s uired to be when the issued to the owner's Signature of Property Date ,/'/5 -/ S , DPem.u s LLc 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 file the documents necessary to obtain an Owner-Builder Permit for my project Scope of Construction Project (or Description of Work),4^or{e Project Location or Address Name of Authorized Agent: Address of Authorized Agent:0 q I declare under penalty of perjury that I am the property owner for the address listed above and I personally tllled out the above information and certify its accuracy Property Owner's Signature Date Print Name of Owner: Note: A copy of the owner's driver's license, fom nota zation, ot other yerification acceptable to ahe egency is required to be prcsented when the permit is issued to verify the propefty owner's signature, PLink:WP51/Counter Activity/Assembly Bills/Notice to Property Form 03-13-20'14 SANTA ANA CITY COUNCIL ature. MPurdo@santa a.a oro Mayor Pro Toh. Ward 6 SThaEro@sanla ana oro Vsa.mre.torAsanla.ana oro MManrn6r@s.nt.-.ne.oro AA4srclr@lalh:rur,s9 P Oavid 8en6sdâ‚¬s OB6oau!,6@entan.. oro RR.vnr@srnE-an..oro Print name of Owner Phone Number of Aulhorized Agent: