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101102941 - Permit
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101102941 - Permit
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Last modified
6/2/2021 8:18:35 AM
Creation date
6/2/2021 8:18:34 AM
Metadata
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Template:
Permit
Permit Number
101102941
Full Address
1319 N Louise St
Permit ID
262623
Master ID Number
2020-157358
Project Name
Reroof
Street Number
001319
Street Direction
N
Street Name
Louise
Street Suffix
St
Building Use Code
Resid-1 unit
Job Types
Reroof
Permit Type
Building
Applied Date
1/27/2020
Issued Date
1/27/2020
Finalized Date
2/14/2020
Flood Zone
X-0602320144J
Description of Work
Partial reroof w/t.o.-Remove and apply TPO to flat area, sheathing to remain/handout given
Nature of Work
Partial Reroof
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l, g. I understand I may obtain more information regarding my obligations as an "employef'from the lnternal Revenue Ser- <br />vr6e, the United States Small Business Administration, the California Department of Beneflt Payments, and the California Divi- <br />sion of Industrial 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.oov for more information about licensed contractors. <br />lL ,o <br />Er.tv l"g <br />dress: <br />I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the <br />all n fi a nct ly responsible for propos construction act ity at the fol owing ad- <br />IL ,, <br />Fppr,""ur <br />lL ,, <br />fri6pro <br />. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all <br />e 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 />vided 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 flnancial 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 Iicensed 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. i/ote; A copv of the propertv owner's driver's license. form notariza- <br />or other verification acc the ,s b the <br />property owner's siqn atu re. <br />Signature of Property Owner Date 27 ?o <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 personal responsibility, 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)OO ? <br />>/C <br />Address of Authorized Agent:A" U Tzzq <br />L <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 />Date 7 .,> 47t <br />Print Name of Owner <br />Note: A copy of the owner's drivels license, form notarization, or other verification acceptable to the agency is re- <br />quired to be presented when the permit is issued to vefify the propefty owner's signature. <br />Pro.iect Location or Address: <br />Name of Authorized Agent: <br />.t 9on <br />Phone Number of Authorized Agent: <br />Property Owneis Signature:
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