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Property Owner Statement <br /> Regarding Construction Responsibilities <br /> Oregon Law requires residential construction permit applicants who are not licensed with the <br /> Construction Contractors Board to sign the following statement before a building permit can be <br /> issued. (ORS 701.325 (2)) <br /> This statement is required for residential building, electrical, mechanical,and plumbing permits. <br /> Licensed architect and engineer applicants,exempt from licensing under ORS 701.010 (7), need not <br /> submit this statement.This statement will be filed with the permit. <br /> Please check the appropriate box: <br /> I own, reside in, or will reside in the completed structure and my general contractor is: <br /> Name CCB# Expiration Date <br /> I will inform my general contractor that all subcontractors who work on the structure must be <br /> licensed with the Construction Contractors Board. <br /> or <br /> IMI will be performing work on property I own, a residence that I reside in, or a residence that I will <br /> reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction <br /> j Contractors Board. If I change my mind and hire a general contractor, I will select a contractor <br /> who is licensed with the CCB and will immediately give the name of the contractor to the office <br /> issuing this Building Permit. <br /> I have read and understand the Information Notice to Homeowners About Construction Responsibilities, <br /> and I hereby certify that the information on this homeowner statement is true and accurate. <br /> •iri T:Dre <br /> ern, )deL <br /> fin ' :me of P rmit Applicant <br /> d y <br /> -- Signatur- of Permit Applicant ate <br /> Permit#: J -5-S — I Z -g& 16 35 — /eC/ o F <br /> Address: 1-� id /v` ,,,,,. 4, <br /> ,�/•_ �u�e ;..7,,tr,.....-- . 0 <br /> 4(;(bAM! 04J ' 43,1-7-i-- N� r�.ed ;x <br /> ‘7*I.V1/ <br /> Issued by: ' Date: VL 9/Z° .. .. <br /> - 6e/ <br /> • <br /> This Copy for Permit Offices <br />