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20166421 - Permit
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20166421 - Permit
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Entry Properties
Last modified
8/4/2021 10:31:18 AM
Creation date
8/4/2021 10:31:17 AM
Metadata
Fields
Template:
Permit
Permit Number
20166421
Full Address
1901 S Evergreen St
Permit ID
243616
Master ID Number
2018-144659
Project Name
Garage Electrical Rewire
Street Number
001901
Street Direction
S
Street Name
Evergreen
Street Suffix
St
Building Use Code
Resid-3 units
Job Types
Miscellaneous
Permit Type
Electrical
Applied Date
7/16/2018
Issued Date
7/16/2018
Finalized Date
7/24/2018
Flood Zone
X-0602320276J
Nature of Work
Electrical
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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 contract with a licensed general building Contractor. <br />O7,/ru t 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any <br />financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the <br />wo-ikmanship or materials.I L'v- <br />LVG I understand I may obtain more information 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 lndustrial Accidents. I also understand I may contact the California Contractors' State License Board <br />(CSLB) at 1-800-321-CSLB (2752) or wvvw.cslb.ca.oov for more information about licensed contractors.6h- <br />W'tO.l am aware of and consenl to an Owner-Builder building permit applied for in my name, and understand that I am <br />the party lega ly nd financi respo nsible for proposed construction activ at the lowi s (,ca-z-address /,/z rZ-e,..c- <br />fu,I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by <br />all applica ble laws and requirements that govern Owner-Builders as well as employers <br />.l%r t 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.'A coDv of the DroDertv wner's driver's license. <br />form notarization, or other verification acceptable to aqencv is reouired to be presented when the Dermit is <br />lssued fo the owner's sir nature. <br />Signature of Property Owner Date .€"2- o le <br />Print name of Owner D onu /c/fr7n p f/< o-z-. <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 />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 notarization, or other verification acceptable to the agency is required lo <br />be presented when the permit is issued to verify the property owner's signature. <br />P i,'!'i-a il,r. nrjA.: f _,, :r.-rr:,iil i t!j:.: i ir .::i.ir t.:: 1,-, :! :': r a <br />SANTA ANA CITY COUNCIL <br />6oulido@santa-a.a oro <br />Vrce.te Sarmienlo <br />vsamienlo@santa ana oro isoloro@san1a-ana oro <br />P. Davd Benavides <br />dbe.avides@san!a'ana.oro ivi eoasrosanta-ana oro slrna eroaosa.t.-ana oro <br />Name of Authorized Agent: <br />Mayor Pro Ten, Wa.d 2 <br />nimartrnez@sa.la-a.a.oro
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