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101102852 - Permit
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101102852 - Permit
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Last modified
6/2/2021 8:18:38 AM
Creation date
6/2/2021 8:18:37 AM
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Permit
Permit Number
101102852
Full Address
421 W Nobel Ave
Permit ID
262296
Master ID Number
2020-157096
Project Name
Re-Roof
Street Number
000421
Street Direction
W
Street Name
Nobel
Street Suffix
Ave
Building Use Code
Resid-Multi-unit
Job Types
Reroof
Permit Type
Building
Applied Date
1/14/2020
Issued Date
1/14/2020
Finalized Date
2/5/2020
Flood Zone
X-0602320278J
Description of Work
T/O existing flat roof and reroof flat portion with new torch down to apartment building. Hand out given. Auth on file.
Nature of Work
Reroof
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\nl:..]l_g. I understand I may obtain more information regarding my obligations as an "employe/'from the lnternal Revenue Ser- <br />vice, the United States Small Business Administration, th,e Callfornia 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.oov for more information about licensed contractors. <br />U^'-4-, O. I am aware of and consent to an Owner-Builder building permit applaed for in my name, and understand that I am the <br />party leg and financiall res onst for con at the fol n s ad- <br />dress (^r.AL t/ <br />\:-]A1 , I agree that, as the party legally and flnancially 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 />\:b, 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. ivote.' A copv of the propertv owner's driver's license, form notariza- <br />Signature of Property Owner Date: I oL7 LLC <br />Print name of Owner p'71+Br lr +FAR 4 d ^nos*-A"^L nr o 4 7.T t4*u "tr"L"*(9 \' <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 <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 Ownef s Signature Date <br />Print Name of Owner: <br />propertv ow ner's sid n atu re. <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 propefty owner's signature.
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