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Permit No: <br /> Address: <br /> Issued by: <br /> <br /> STATEMENT: <br />INFORMATION NOTICE TO PROPERTY OWNERS <br />ABOUT CONSTRUCTION RESPONSIBILITIES <br /> <br /> Date: <br />FOR OFFICE USE ONLY. <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, and initial box I and either box 2A or 2B: <br /> <br />1.~,1 own, reside in, or will reside in the completed structure. <br />2. A.F~ 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 witI~ the Construction Contractors Board. <br /> <br />OR <br /> <br />I will be my own general contractor. <br /> <br /> If I hire subcontractors, i will hire only subcontractors registered with the <br /> Construction Contractors Boa, rd. If I change my mind and ~1o hire a general <br /> contractor, I will contract w~th a contra.c, tqr who.is registered w~th the <br /> Construction Contractors Board and I wdl ~mmed~ately notify the office <br /> issuing this building permit of the name of the contractor. <br /> <br />I hereby certify that the above information is correct and that I have read and understand <br />the Ir~tormation Notice to Property Owners about Construction Responsibilities on the <br />reverse side of this form. __ <br /> <br /> /// Signature of Permit Applic~Cnt - Date <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 />