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20166089 - Permit
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20166089 - Permit
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Last modified
6/9/2021 8:51:16 AM
Creation date
6/2/2021 10:06:55 AM
Metadata
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Template:
Permit
Permit Number
20166089
Full Address
521 E Beverly Pl
Permit ID
242352
Master ID Number
2018-143838
Project Name
Miscellaneous Counter1 Permit
Street Number
000521
Street Direction
E
Street Name
Beverly
Street Suffix
Pl
Building Use Code
Resid-2 units
Job Types
Miscellaneous
Permit Type
Electrical
Applied Date
6/7/2018
Issued Date
6/7/2018
Finalized Date
3/1/2019
Flood Zone
X-0602320276J
Description of Work
handout given
Nature of Work
Service Meter
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licensed subcontractors and the number of structures does not exceed four within any calendar years, or all of the work is <br />performed under conkact with a licensed general building Contractor. <br />(1 .-J ! a. t understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any <br />finf,ncial or personal injuries sustained by any subsequent owne(s) that result from any latent construction defects in the <br />workmanship or materials. <br /><1 .J C g. t understand I may obtain more anformation regarding my obligations as an "employer" from the lnternal Revenue <br />Service, the United States Small Business Administration, the California Department of Benefit Payments, and the <br />California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board <br />(CSLB) at 1-800-321-CSLB (2752) or lwvw.cslb.ca.qov for more information about licensed contractors. <br />I) L I O. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am <br />lhl"*I'"t'"'""t+$i"" <br /><)/J L 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by <br />all applicable laws and requirements that govern Owner-Builders as well as employers. <br /><: /^ <br />. \L12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the <br />information I 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 <br />have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain <br />as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. lt is also important for <br />you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your <br />property, you may be held liable for damages. lf you obtain a permit as Owner-Builder and wish to hire Contactors, you will <br />be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' <br />compensation insurance coverage. <br />Before a building permit can be issued, this form must be completed and signed by the property owner and <br />returned to the agency responsible for issuing the permit. /Vote.'owner's driver's license <br />form notarization, or other fication acceDtable to the aoencv is required to be ted when the Dermit is <br />Signature of Property Owner 5i\'ricn Cr oz Date c-7-t8 <br />Print name of Owner 3,\v ic" Lt,tZ <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. <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 lhe property owner for the address listed above and I personally filled out the above <br />information and certify its accuracy. <br />Date <br />Print Name of Ow.rer <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 presenled when the permit is issued to yerify the property owner's signature. <br />SANTA ANA CITY COUNCIL <br />moulido@sa.ta-ana oro <br />Mayor P.o Tem Ward 2 <br />mrmarl.ezrOsanla-ana oro <br />vicenre Samienlo <br />vsamlenlo@sanla-ana.oro so oroAsa.ta-ana oro <br />P Oav d B€navdes <br />dbenavldes@sa.la'ana oro ivi eoasosanta ana.oro strnarero@sa.ra-ana.oro <br />issued to verifu the DroDeftv owner's signature. <br />Property Owner's Signature:
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