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20170543 - Permit
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20170543 - Permit
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Last modified
6/1/2021 1:27:15 PM
Creation date
6/1/2021 1:27:14 PM
Metadata
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Template:
Permit
Permit Number
20170543
Full Address
1418 S Pacific Ave
Permit ID
262095
Master ID Number
2020-156950
Project Name
Miscellaneous Counter1 Permit
Street Number
001418
Street Direction
S
Street Name
Pacific
Street Suffix
Ave
Building Use Code
Resid-1 unit
Job Types
Miscellaneous
Permit Type
Electrical
Applied Date
1/7/2020
Issued Date
1/7/2020
Finalized Date
3/4/2020
Flood Zone
X-0602320257J
Description of Work
Electrical, outlets, light switches, light fixtures. Owner-Builder form on file.
Nature of Work
Electrical
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\' <br />{S g. I understand I may obtain more information regarding my obligltionitrs an "employe/' from the lnternal Revenue Ser- <br />vice, the United States Small Business Administration, the California Department of Benefit Payments, and the California Divi- <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 />$L 10. 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 legal and financially ib for co n at the fol <br />d <br />ad-o1L70 <br />J'* ,1. I agree that, as the party legally and financially 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 />lW2 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 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 propeftv 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 ro pertv own er's si q n atu re. <br />Signature of Property Owner Date: \I f,. aL'-> <br />Print name of owner U, t(""e l GA TLEDYF\ <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 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 />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 />information 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 verification acceptable to the agency is re- <br />quired to be presented when the permit is rssued to verify the propefty owner's signature. <br />l^
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