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Address: / ! '~-~- ! <br />Issued by:.~ ~ Date: <br /> <br /> FOR OFFICE USE ONLY <br /> STATEMENT: <br />INFORMATION NOTICE TO PROPERTY OWNERS <br /> ABOUT CONSTRUCTION RESPONSIBILITIES <br /> <br />Note: Oregon Law, ORS 701.055(4), requires residential building permit applicants <br />who are not registered with the Construction Contractors Board to sign the <br />following statement before the building permit can be issued. Licensed Architect <br />and Engineer applicants, exempt from registration under ORS 701.010(7), need <br />not submit this statement. This statement will be filed with the permit. <br /> <br />Fill in the applicable blanks, an.d' initial box I and either box 2A or 2B: <br /> <br />I own, reside in; or will reside in the completed structure. <br /> <br />My general contractor is , <br />Contractor registration number <br /> <br />I will instruct my general contractor that all subcontractors who work on <br />the structure must be registered with the Construction Contractors Board. <br /> <br />OR <br /> <br />will be my own general contractor. <br /> <br />If I hire subcontractors, I will hire only subcontractors registered with the <br />Construction Contractors Board, If I change my mind and ~1o hire a general <br />contractor, I will contract with a contractor who is registered w~th the <br />Construct(on Contractors Board and I will immed ate y notify the off ce <br />issuing th~s building permit of the name of the contractor. <br /> <br />! hereby certify that the above inl~ormafion is correct and that I have read and understand <br />the Information Notice to Property Owners about Construction Responsibilities on the <br /> <br />reve~e of this for~m. /. <br /> . <br /> <br />CONSTRUCTION CONTRACTORS BOARD <br />0244J 1/90 <br /> <br />WHITE COPY TO ISSUING AGENCY PERMIT FILE <br />PINK COPY TO APPLICANT <br /> <br /> <br />