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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 /> N, I 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 /> 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 /> Print Name of Permit Applicant <br /> 411040. <br /> Signature of Permi A•Frfic- Date <br /> 955-22—o0ec <br /> Permit#: -22 "UOZCQO3- GIe& OF <br /> \ <br /> Ctt V) S <br /> Address: . mol%s/";•'� <br /> N� Ytumv / <br /> Issued by: Date: _3 214 2. <br /> This Copy for Permit Offices <br />