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102104592 - Permit
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102104592 - Permit
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Last modified
6/3/2021 11:14:37 AM
Creation date
6/3/2021 11:14:36 AM
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Permit
Permit Number
102104592
Full Address
854 E Normandy Pl
Permit ID
268188
Master ID Number
2020-161340
Project Name
Lucero Window Change out and Reroof
Street Number
000854
Street Direction
E
Street Name
Normandy
Street Suffix
Pl
Building Use Code
Resid-1 unit
Job Types
Alteration
Permit Type
Building
Applied Date
9/8/2020
Issued Date
9/8/2020
Finalized Date
11/2/2020
Flood Zone
X-0602320276J
Description of Work
Legalize reroof and legalize window change outs. Tear off existing roof material and install new comp shingle roof material. 8 windows to white vinyl. Handout given. Owner-Builder form on file.
Nature of Work
N/V - Reroof/Windows
Document Relationships
102104592 - Plan
(Plan)
Path:
\Building\Plans\N\Normandy Pl\854 E Normandy Pl
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Mn ,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 Departmgnt of BFneflt Payments, and the Caljfornia 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 />Fpt rc.I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the <br />i?y,':rygLT^'i]);y'fry,tl1i':r,g'rty"kuction activitv at the forrowins ad- <br />[4,'t 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 />[y'l,, t agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I'have provided on this form. <br />Licensed contractors ale 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 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 permit. /Vote.' A coov of the orooertv owner's driver's license, form notariza- <br />tion. or other verification acceotable to the adencv is reouired to be presented when the permit is issued to verifv the <br />Drooertv owner's sionature, <br />Signature of Property Owner i*k/c, ),4irt q-tDate <br />Print name of Owner h <br />AUTHORIZATION OF AGENT TO ACT ON PROPERW OWNER'S BEHALF <br />Excludlng the Notice to Property Owner, the execution of which I understand is my personal responsibllity, I hereby authorize <br />the following person(s) to act as my agent(s) to apply for, sign, and file the documenls necessary to obtain an Owner-Builder <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 <br />Print Name of Owner <br />Note: A copy of the owner's driver's license, form notari2ation, or other veritication acceptable to the agency is re- <br />quired to be presented when the permit is rssued to verify the property owner's signature.
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