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20170716 - Permit (2)
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20170716 - Permit (2)
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Last modified
11/10/2022 2:43:12 PM
Creation date
11/10/2022 2:43:10 PM
Metadata
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Permit
Permit Number
20170716
Full Address
4030 W Morningside Ave
Permit ID
262845
Master ID Number
2020-157507
Project Name
Miscellaneous Counter1 Permit
Street Number
004030
Street Direction
W
Street Name
Morningside
Street Suffix
Ave
Building Use Code
Resid-1 unit
Job Types
Miscellaneous
Permit Type
Electrical
Applied Date
1/31/2020
Issued Date
1/31/2020
Finalized Date
2/27/2020
Flood Zone
A-0602320143J
Description of Work
Upgrade. Hand out given/Auth on file.
Nature of Work
Service Meter
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Lb tunderstand I may obtain more information regarding my obligations as an "employed'from the lnternal Revenue Ser- <br />viue, the United States Small Business Administration, the Calit'crnia Department of Benefit Payments, and the California Divi- <br />sion of lndustrial Accidents. I also understand I may contact the Califarnia Contractors' State License Board (CSLB) at '1-800- <br />321-CSLB (2752)or www.cslb.ca.qov for more information about licensed contractors <br />LlL- rc.1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the <br />party <br />d ress <br />legally and financially responsible for prop osed construction acti at the followinty g ad-:o <br />LiL ll .l agree that, as the party legally and financially responsible for this proposed construction activity, I witl abide by all <br />applicable laws and requirements lhat govern Owner-Builders as well as employers. <br />/, <br />o l" P.l agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I <br />have provided on this form. <br />Licensed contractors are regulated by laws designed to protect the public. lf you contract with someone who does not have a <br />license, the Contractors' State License Board may be unable to assist you with any flnancial loss you may sustain as a result of <br />a complaint. Your only remedy against unlicensed Contractors may be in civil court. lt is also important for you to understand <br />that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held <br />liable for damages. lf you obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible for verifying <br />whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. <br />Before a building permit can be issued, this form must be completed and signed by the property owner and returned <br />to the agency responsible for issuing the p ermit. /Vote; A copv of the propertv owner's driver's license, form notariza- <br />tion. or other verification acceDtable to the aoencv is reouired to be presented when the permit is issued to verifv the <br />Sig nature of Property Own <br />Print name of Owner ,r tl,Lrz-Q amtr<Ztl' <br />AUTHORIZATION OF AGENT TO ACT ON PROPERry OWNER'S BEHALF <br />Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize <br />the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder <br />Permit for my project. <br />Project Location or Address <br />Date: >)o).) <br />t[uL.L0 z <br />Name of Authorized Agent <br />Address of Authorized Agent: <br />Phone Number of Authorized Agent: <br />Property Owner's Sig nature Date <br />Print Name of Owner: <br />Note: A copy of the owner's driver's license, form notarization, or other verffication acceptable to the agency is re- <br />quired to be presented when the permit is issued to verify the propefty owner's signature. <br />propertv owner's sio natu re. <br />ScopeofConstrUctionProject(orDeScriptionofWork): <br />I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above <br />information and certify its accuracy.
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