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101102760 - Permit
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101102760 - Permit
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Last modified
6/2/2021 8:19:32 AM
Creation date
6/2/2021 8:19:31 AM
Metadata
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Permit
Permit Number
101102760
Full Address
1923 W Jan Way
Permit ID
262039
Master ID Number
2020-156905
Project Name
Alvarez Residential Reroof
Street Number
001923
Street Direction
W
Street Name
Jan
Street Suffix
Way
Building Use Code
Resid-1 unit
Job Types
Reroof
Permit Type
Building
Applied Date
1/6/2020
Issued Date
1/7/2020
Finalized Date
1/17/2020
Flood Zone
X-0602320257J
Description of Work
Reroof house & attached garage - remove comp, replace any damaged sheathing, install new 30-year shingles. Handouts given. Owner authorization on file.
Nature of Work
Reroof
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--t-S. I understand I may obtain more information regarding my obligations as an "employel'from the lnternal Revenue Ser- <br />vic6, 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.oov for more information about licensed contractors. <br />=LtO <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 />party I <br />dress: <br />nd flnan onsible for pro tructio activity at the foll ng ad-d cons(.2?az-r <br />SJ-f f 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 />--:J.- <br />have <br />12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I <br />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 cou(. 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 prope(y, 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. /Vote: A copv of the propertv owner's driver's license. form notariza- <br />tion. or other verification acceDtable to the aoencv is reduired to be presented when the permit is rssued to verifv the <br />propeftv owner's sidnature. <br />Signature of Property Owner o^r", , f 4f 1' ;r, <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 <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)?"lc<ce- 31","e <(fr ( tLl <br />Project Location or Address <br />R <br />I I L3 W Soc^- U,.^.r S^ ,^\A^.U.'iL-l(! <br />I <br />Name of Authorized Agent : <br />Address of Authorized Agent: <br />Property Owner's Signature <br />Print Name of Owner: <br />ct ,\Ct 'I at Q z-zttu <br />Phone Number of Authorized Agentl <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 ,lrl.r, <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 verw the property owner's signature. <br />l-lt\
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