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102104409 - Permit
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102104409 - Permit
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Entry Properties
Last modified
6/9/2021 2:45:35 PM
Creation date
6/3/2021 11:14:33 AM
Metadata
Fields
Template:
Permit
Permit Number
102104409
Full Address
2214 W Edinger Ave
Permit ID
267739
Master ID Number
2020-161049
Project Name
N/V Windows
Street Number
002214
Street Direction
W
Street Name
Edinger
Street Suffix
Ave
Building Use Code
Resid-Multi-unit
Job Types
Alteration
Permit Type
Building
Applied Date
8/25/2020
Issued Date
8/25/2020
Finalized Date
11/3/2020
Flood Zone
X-0602320257J
Description of Work
Legalize window change outs through out/same size, same style
Nature of Work
Window C/O
Document Relationships
102104409 - Plan
(Plan)
Path:
\Building\Plans\E\Edinger Ave\2214 W Edinger Ave
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r: \ L 9. I understand I may obtain more information regarding my obligations as an "employer" 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.qov for more information about licensed contu'actors. <br />E3-10. 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 <br />dress <br />legally and financially responsible for proposed construction activity at the following ad- <br />E)L:l 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 />F i (l Z. t 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 desrgned 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 flnancial 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 OwnerBuilder 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, /Vofe.' A copv of the DroDertv owner's driver's license, form notariza- <br />tion. ot other verification acceptable to the aoencv is required to be presented when the permit is issued to verifv the <br />Dropertv ow ner's s ionatu re. <br />L t u+t(,A AL <br />Signature of Property Owner Date t )>r-/= ts <br />Print name of Owner F.rz,a w' ct 5 ( t Jeu,</l 1: rJ A\t-e-t <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-Burlder <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 Owner's Signature Date s-o3A(> <br />Print Name of Ow net: (--.tzA r<Zt I (a I a U , er<. L )J /*Vf-7 <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 vetry the propafiy owner's signature. <br />r+A <br />=-=- <br />AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
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