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30138677 - Permit (2)
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30138677 - Permit (2)
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Last modified
11/21/2022 2:38:27 PM
Creation date
11/21/2022 2:38:26 PM
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Permit
Permit Number
30138677
Full Address
402 W Fourth St
Permit ID
235590
Master ID Number
2017-139648
Project Name
Miscellaneous Counter1 Permit
Street Number
000402
Street Direction
W
Street Name
Fourth
Street Suffix
St
Building Use Code
Retail/Service
Job Types
Tenant Improvement
Permit Type
Plumbing
Applied Date
10/30/2017
Issued Date
10/30/2017
Finalized Date
1/7/2019
Flood Zone
X-0602320276J
Description of Work
Install new sinks, washer, alter sewer line, water heater and new water piping. Auth on file.
Nature of Work
Plumbing
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-4,, I am aware of and consent to an Owner-Builder bullding permit applied for in my name, and understand that I am <br />the party legally and frnancially responsible for proposed construction activity at the followingaddress: 4a Z ut ''t n srruzcr <br />''"'" -runderstand <br />as an Owner-Builder if I sell the'property for which this permit is issued. I may be held liable for any <br />financial or personal injuries sustained by any subsequent owhe(s) that result from any lalent construction defects in the <br />workmanship or materials. <br />-/9-' _9 I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue <br />Service, the Unrted States Small Business Administration. the California Depanment of Benefit Payments, and the <br />California Division of lndustrial Accidents. I also understand I may contact lhe Californra Contractors' State License Board <br />(CSLB) at 1-800-321-CSLB (2752)or www.cslb.ca.oov for more information about Iicensed contractors <br />-4-9-- 11.1 agree that, as the party legally and financially responsible for this proposed construction activity. I will abide by <br />all applicable laws and requirements that govern Owner-Builders as well as employers. <br />-&r l agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the <br />information I have provided on this form. <br />Lrcensed contractors are regulated by laws designed to protect the public. lf you contract with someone who does not <br />have a license. the Contractors' State License Board may be unable to assist you with any financial loss you may sustain <br />as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. lt is also important for <br />you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your <br />property, you may be held liable for damages. lf you obtain a permit as Owner-Builder and wish to hire Contactors, you wil <br />be responsible for verifying whether or not those Contractors are properly Iicensed and the status of their workers' <br />compensation insurance coverage. <br />Before a building permit can be issued, this form must be completed and signed by the property owner and <br />returned to theagency responsible for issuing the permit. A/ofe: A coDv ofthe Dropeftv owner's driver's license, <br />form notarization, or other verification acceptable to the agency is required to be presented when the permil is <br />issued to verify the propedy owner's sianature. <br />Signature of Property Owner <br />Print name of Owner <br />Date: i Zui -7 <br />AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF <br />Excluding the Notice to Properly Owner, the execution of which I understand is my personal responsibility, I hereby authorize the <br />following person(s) to acl as my agent(s) to apply for, sign. and file the documents necessary to obtain an Owner-Buiider Permit for my <br />project. <br />LJ A'nlScope of Constructron Pro,ect (or Description of Work)A s l.) ,L 0 (e<-'^Y S <br />Pro,ect Location or Address 4aLu.t 4fi srz<er <br />Name of Authorized Agent:-7Wf Bepoo,.-.t <br />Address of Authorized Agent:129 ut, Nt t-s(r\t 9lv--e <br />I declare under penalty of perjury that I am the prop€rty owner for the address listed above and I personally filled out the above <br />information and certify its accuracy <br />Property Owner's Signature <br />Print Name of Owner:lR -. a"', (),t'"-,rs,- <br />Date: lO 2 'Zbl <br />Note; A copy of the owner's drlver's licensa, form nolarization, or other yerlfication acceptable lo the agsncy is required to <br />be presented when lhe permil is issued to verify the property owner's signaturc. <br />SANTA ANA CITY COUNCIL <br />t?16t, Pio 'Idr lryaro r <br />vslmrlo6.rll.i€ o.a Mm!cu.@sr. s^. @ <br />P Oad B.ruuda <br />DE&.$d6o.ar!tr-r.a orc ST'EcorOe.t 'an. oE <br />4'/<- <br />RRe6r@sml..ena o.o <br />Phone Number of Authorized Agent.
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