My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
10194881 - Permit
PBA
>
Building
>
Permits
>
B
>
Brook St
>
2806 W Brook St
>
10194881 - Permit
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
6/2/2021 9:42:20 AM
Creation date
6/2/2021 9:42:19 AM
Metadata
Fields
Template:
Permit
Permit Number
10194881
Full Address
2806 W Brook St
Permit ID
236328
Master ID Number
2017-140066
Project Name
Enriquez Residential Reroof
Street Number
002806
Street Direction
W
Street Name
Brook
Street Suffix
St
Building Use Code
Resid-1 unit
Job Types
Reroof
Permit Type
Building
Applied Date
11/21/2017
Issued Date
11/21/2017
Finalized Date
6/8/2018
Flood Zone
X-0602320256J
Description of Work
Tear off existing roof material and install new comp shingle roof material. Owner-Builder form on file. Handout given.
Nature of Work
Reroof
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
4
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
Show annotations
View images
View plain text
J_.L g. t understand I may oblain more information regarding my obligations as an "employer" from the lnternal Revenue Service, the <br />United States Small Business Administration, the California Department of BenDflt Paynrents, and the Calilornia Division of lndustrial <br />Accidents. lalso understand lmaycontactthe California Contractors' State License Board (CSLB) at 1-800-32'1-CSLB (2752) or <br />www.cslb.ca.qov for more information about licensed contractors. <br />l€, O. , am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the party <br />legally and financially responsible for proposed construction activity at the followingaddress: 7.QO6 w. lSnogk e -J-' <br />J ., 1 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 />JLl2.lagreetonotifytheissuerofthisformimmediatelyofanyadditions,deletions,orchangestoanyoftheinformationlhave <br />provided on this form. <br />Licensed contractors are regulated by laws designed to protect the public. lfyou contract with someonewhodoes not have a license, <br />the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. <br />Youronly remedy against unlicensed Contractors may be in civil court. ltisalso important for you to understand thatif an unlicensed <br />Contractor or employee ofthat individual orfirm is injured while working on your property, you maybe held liable for damag es. lf you <br />obtain a permit as Owner-Builder and wish to hire Contactors, you will be responsible for verifying whether or not those Contractors are <br />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 to the <br />agency responsibfe for issuing the permit. Nole: A copv of the propeftv owner's driver's license, form notarization. or other <br />verification acceptable to the aqency is recuired to be presented when the permit is issued to verify the propeftv owner's <br />sianature. <br />Signature of Property Owner \')Date il-2-l-'Lat7 <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 the <br />following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my <br />Project Location or Address <br />Name of Authorized Agent <br />I declare under penalty of perjury that I am the property owner for the address listed above and I personally lllled 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 required to <br />be presented when the permit is issued to verify the property owner's signature. <br />PL in k:\i, P5l iCcunterAclivilylAssemblyB iils:l'lctice ic Prcseily Fcrm <br />SANTA ANA CITY COUNCIL <br />moul do6sa.ta 'ana oro <br />Mayor Pro Tem, Ward 2 <br />mi6an nez@santa ana.oro <br />Mcenle Samieno <br />vsarmrenbras6nla ana.oro 6olorio@santa-ana.oro <br />P. Oav d Benavides <br />dbenaudes@sanla-ana oro vrlleoaslasanla'ana oro sl naero@sanla-ana oro <br />Print name of Owne, \Ose Zxf-rtl,rEZ <br />ScopeofConStruCtionProjeCt(orDeScriptionofWork):- <br />Address of Authorized Agent: <br />Phone Number of Authorized Agent: _
The URL can be used to link to this page
Your browser does not support the video tag.