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Report (40) 11 _ Property Owner Statement Regarding Construction Responsibilities %Ai If; Oregon Law requires residential construction permit applicants who are not licensed wi ITil ` Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical,mechanical,and plumbing per mits. Licensed architect and engineer applicants,exempt from licensing under ORS 701.010(7), need not submit this statement.This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that a II subcontractors who work on the structure must be licensed with the Construction Contractors Board. / or I will be performing work on property I own, a residence that I reside in, or a residence that I w ill reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this hom eowner statement is true and accurate. a O k)(PrKFt CP-t51-0 r: 7 Print Name of Permit Applicant a Signature of Per mil" Date Permit#: /teif j�7.0/`/ 0,00:2 7 Address: /A ?fes S o'-fNf/r g'.s6 S% %-,� -776/746 0,e- y Issued by: Date: -13/77,21/1X !1 ` 644 (/ This Copy for Permit Offices Q ., • U.) e From: fcrist :,.‘,ristgyaoo..corn di? "- Subject: Window 4 t 5 38 PM -' , Date: February 12,201 a ,,,t ,,..arloo P -c--p -s -j- To: loana Cristurean im....u.,....!! ..... . ! ...:. .... 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