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101103298 - Permit
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101103298 - Permit
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Last modified
6/3/2021 8:44:26 AM
Creation date
6/3/2021 8:44:25 AM
Metadata
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Template:
Permit
Permit Number
101103298
Full Address
1030 1/2 W Carlton Pl
Permit ID
263673
Master ID Number
2019-155084
Project Name
Flores - ADU Garage Conversion
Street Number
001030
Partial
1/2
Street Direction
W
Street Name
Carlton
Street Suffix
Pl
Building Use Code
Resid-2 units
Job Types
Alteration
Permit Type
Building
Applied Date
2/26/2020
Issued Date
9/11/2020
Finalized Date
12/22/2020
Flood Zone
X-0602320257J
Description of Work
Convert existing 400 sq. ft. det garage into a new ADU. SAUSD paid on #4008
Nature of Work
ADU Conversion
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lrl-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, 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 />lr <br />L_L10.1 am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the <br />party legally and financially responsible for proposed construction activity at the following ad- <br />dress: <br />)-rJJll.l 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 />l'-I , f 12.1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the anformation 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 agaanst 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 p ermit. ,Vote. A copv of the propertv owner's driver's license, fgrm nota za- <br />tion, or other verification acceptable to the aqencv is requ ired to be Dresented when the Dermit is issued to verifv the <br />proDeftv owner's sionature. <br />Signature of Property Owner e o/,,.y' /z,f e5z Date 7- t/ 2o <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 pro.ject. <br />Scope of Construction Project (or Description of Work) <br />Project Location or Address <br />Name of Authorized Agenti <br />Address of Authorized Agent <br />Phone Number of Authorized Agent: <br />I declare under penalty of perjury that I am the prope(y owner for the address listed above and I personally fllled out the above <br />information and certify its accuracy. <br />Property Ownef 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 re- <br />quired to be prcsented when the permit is issued to verify the property owner's signature.
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