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30341946 - Permit (2)
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30341946 - Permit (2)
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Last modified
11/14/2022 2:10:43 PM
Creation date
11/14/2022 2:10:41 PM
Metadata
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Permit
Permit Number
30341946
Full Address
1610 W Edinger Ave Unit# A
Permit ID
263403
Master ID Number
2020-157782
Project Name
Dental chairs, sinks, and water heater
Street Number
001610
Street Direction
W
Street Name
Edinger
Street Suffix
Ave
Unit Number
A
Building Use Code
Office
Job Types
Miscellaneous
Permit Type
Plumbing
Applied Date
2/19/2020
Issued Date
2/19/2020
Finalized Date
3/2/2020
Flood Zone
X-0602320257J
Description of Work
Per C of O correction-Dental chairs, sinks, water heater and cap fixtures. Auth on file.
Nature of Work
Fixtures
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/ <br />(l* <br />' <br />understand I may obtain more information regarding my ob'ligations as an "employei'from the lnternal Revenue Ser- <br />vice, the United States Small Business Administration, the Califomia Department of Benefit Payments, and the California Divi- <br />sion of lndustrial Accidents. lalso understand lmaycontactthe Califorrria Contractors' State License Board (CSLB) at1-800- <br />321-CSLB (2752) or www.cslb.ca.oov for more information about licensed contractors. <br />A <br />i \-210. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the <br />party legally and financially responsible for proposed construction activity at the following ad- <br />dress: <br />1. I agree that, as the party legally and flnancially responsible for this proposed construction activity, I will abide by all <br />applicable laws and requirements that govern Owner-Builders as well as employers. <br />(\" I 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 financial 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 li <br />Y Before a building permit can be issued, this\ to the agency responsible for issuing the pe <br />censed and the status of their workers' compensation insurance coverage. <br />form must be completed and signed by the property owner and returned <br />rmit. ,Vote.' A coDv oLthe ploperty owner's driver's license, form notariza- <br />o d when the rmit is issued to the <br />DroDertv ow ner's siqn atu re. <br />Sig nature of Property Owner Date Z t I6 ?tc <br />Print name of Owner B Lea- <br />AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF <br />Scope of Construction Project (or Description of Work)ir s+a.il ,'h Iatt"tl dprhLrr^,t. C (oler <br />r l a,le, <br />tr. -e QT ku< S.+'& 4 A 9^^1" Axq d 270 <br />lo l',on 14 ^ <br />Address of Authorized Agent:O D, Ed;€f ftr.,". 9u-,le* A sa,"+r^ h^cA qL70 <br />Phone Number of Authorized Agent 7t4-) r+>o+t8 <br />I declare under penalty of perjury that I am the property owner r the address listed above and I personally fllled out the above <br />information and certify its accuracy <br />Property Owneis Signature Date 7-[l3 I !_o <br />Print Name of Owner Br.l^".L Lt <, <br />Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is re- <br />quired to be prcsented when the permit is issued to verffy the propefty owner's signature. <br />Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authodze <br />the following person(s) to act as my agent(s) to apply for, srgn, and file the documents necessary to obtain an Owner-Builder <br />Permit for my proJect. <br />Project Location or Addressl <br />Name of Authorized Agent:
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