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10496533 - Permit (2)
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10496533 - Permit (2)
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Last modified
12/8/2022 4:20:20 PM
Creation date
12/8/2022 4:20:18 PM
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Permit
Permit Number
10496533
Full Address
310 E Goetz Ave
Permit ID
241862
Master ID Number
2018-143471
Project Name
Theders Demolition
Street Number
000310
Street Direction
E
Street Name
Goetz
Street Suffix
Ave
Building Use Code
Manufacturing
Job Types
Demolition
Permit Type
Building
Applied Date
5/23/2018
Issued Date
6/7/2018
Finalized Date
7/26/2018
Flood Zone
X-0602320278J
Description of Work
$5000.00 to be added to future Ti for accessibility compliance. Demo unpermitted shade structure and interior mezz.
Nature of Work
Demo
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licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is <br />performed under contract with a licensed general building Contractor. <br />4t A. I understand as an Owner-Builder if lsell the property for which this permit is issued, I may be held liable for any <br />/ftiancial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the <br />workmanship or materials. <br />lL-./ 9. I understand I may obtain more information regarding my obligations as an "employer" from the lnternal Revenue <br />6gr/vice, the United States Small Business Administration, the California Department of Benefit Payments, and the <br />California Division of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board <br />(CSLB) at 1-800-321-CSLB (2752) or Wvvw.cslb.ca.qov for more information about licensed contractors. <br />l),- ) to <br />Fi6nv <br />address: <br />I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am <br />legally and financially responsible for proposed construction activity at the following <br />u4/. / ll.l agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by <br />y'all bpplicable laws and requirements that govern Owner-Builders as well as employers. <br />ALIZ.l agree to notify the issuer of this form immediately of any additions, detetions, or changes to any of the <br />,{nf6rmation I 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 <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 will <br />be responsible for verifying whether or not those Contractors are properly licensed 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 the agency responsible for issuing the permit. Note: A copv of the propettv owner's driver's license, <br />form notarization, or other verificat!94 acceptable to the agency is required to be ted when the permit is <br />issued to verifu the ertv owner's sianature. <br />Signature of Property Owner Date 6/z / 7g <br />Print name of Owner <br />AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF <br />Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the <br />following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my <br />prolect. <br />Scope of Construction Project (or Description of Work)o shJe-4A /a //ra <br />Project Location or Address <br />Name of Authorized Agent <br />Address of Authorized Agent <br />Phone Number of Authorized Agent: <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 />inlormation and certify its accuracy. <br />Property Owner's Signature Date <br />Print Name of Owner: <br />Note: A copy of the owner's driver's license, form notarization, or other yerification acceptable to the agency is required lo <br />be presented when the permit is issued to yerify the propedy owner's signature.,-,., <br />SANTA ANA CITY COUNCIL <br />mour do@sa nta-a.a oro <br />Mayor Pro Tem, Wa.d 2 <br />m ma,line2iosanta€na ora <br />Vce.te Sarmrenlo <br />!sarm enlo@santa-ana orc isolor o@sanla-ana.oro <br />P. Oav d Benavrdes <br />dbe.avrdes@sanra-ana.oro ivilleg-a!@E!E:4c.es sl.ae.oAsania-a.e ora
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