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101105975 - Permit
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101105975 - Permit
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Last modified
9/8/2021 5:05:53 PM
Creation date
9/8/2021 5:05:52 PM
Metadata
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Template:
Permit
Permit Number
101105975
Full Address
4914 W Flight Ave
Permit ID
272769
Master ID Number
2021-164532
Project Name
Reroof
Street Number
004914
Street Direction
W
Street Name
Flight
Street Suffix
Ave
Building Use Code
Resid-1 unit
Job Types
Reroof
Permit Type
Building
Applied Date
2/25/2021
Issued Date
2/25/2021
Finalized Date
3/15/2021
Flood Zone
X-0602320256J
Description of Work
Reroof house & attached garage - remove existing, replace any damaged sheathing, install comp shingles. Handouts given.
Nature of Work
Reroof
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U I S. 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. lalso 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 />AL10. 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 legally and financially responsible for proposed construction activity at the following ad- <br />dress: <br />Lnl// ll.l agree that, as the party legally and financially responsible for thas proposed construction activity, I will abide by all <br />applicable laws and requirements that govern Owner-Builders as well as employers. <br />,.. <br />/fu:rlZ I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I <br />\na!e 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 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 p ermit, /Vofe. A copv of the prepefttt oulner's driver's license, form notariza- <br />tion. or other verification acceDtable to the adencv is reou re d to be presented when the permif is issued to verifv the <br />proDertv ow ner's sion atu re. <br />Signature of Property Owner l/tdttnr/tz;:,{Date-fz <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 flle the documents necessary to obtain an Owner-Builder <br />Permit for my project. <br />Scope of Construction Project (or Description of Work) <br />Project Locataon 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 notarization, or other verification acceptable to the agency is re- <br />quired to be presented when the permit is issued to verify the property owner's signature. <br />I
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