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40134946 - Permit
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40134946 - Permit
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Entry Properties
Last modified
6/1/2021 1:26:42 PM
Creation date
6/1/2021 1:26:41 PM
Metadata
Fields
Template:
Permit
Permit Number
40134946
Full Address
2606 N Flower St
Permit ID
268766
Master ID Number
2020-161798
Project Name
Cossaboom Residence Water Heater & AC Unit
Street Number
002606
Street Direction
N
Street Name
Flower
Street Suffix
St
Building Use Code
Resid-1 unit
Job Types
Miscellaneous
Permit Type
Mechanical
Applied Date
9/29/2020
Issued Date
9/29/2020
Finalized Date
10/8/2020
Flood Zone
X-0602320144J
Nature of Work
Comp
Document Relationships
40134946 - Plan
(Plan)
Path:
\Building\Plans\F\Flower St\2606 N Flower St
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L, I understand I may obtain more information regarding my obligations as an "employer'' from the lnternal Revenue Ser- <br />Vce, the United States Small Business Administration, the California Department of Benefit Payments, and the California Divr- <br />sion of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-800.. <br />321-CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors. <br />to an Owner-Builder building permit applied for in my name, and understand that I am the <br />le for proposed constru <br />-Sh..zz-[. Saurta. <br />ction activity at the following ad- <br />2|. I agree that, as the party legally and flnancially responsible for this proposed construction activity, I will abide by all <br />ffilicable laws and requirements that govern Owner-Builders as well as employers. <br />-Lrr 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 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 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 permit. Note: A copv of the propertv owner's driver's license, form notariza- <br />tion. or other verification acceptable to the aqencv is required to be presented when the permit is issued to verifv the <br />p ropertv owner's si o n atu re. <br />Signature of Property Owner Date:?-zq-Hu <br />Print name of Owner <br />AUTHORIZATION OF AGENT TO ACT ON PROPERW OWNER'S BEHALF <br />Excluding the Notice to Property Owner, the execution of which I understand is my personalresponsibility, 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 />Scope of Construction Project (or Description of Work) <br />Project Location or Address: <br />A\.,a.f A QZPS <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 the property owner for the address listed above and I personally filled out the above <br />information and certify its accuracy <br />Print Name of Owner:rol <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 presented when the permit is issued to verify the propefi owner's signature. <br />Property Owner's Signature:o^r", Q-2q- u)t <br />Co=s,boon
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